La cultura dell’Evidence Based Practice dalle “Notes on...” di Florence Nightingale ai moderni Journal Club: l’esperienza dell’ASST Niguarda.

Cecilia Malabusini

Nursing Inquiry 2009; 16 (2): 133-43 The women who nursed during the Crimean War present a picture of nursing in the process of evolving into one of the many new Victorian professions. The approximately 219 women for whom we have records illustrate the sharply stratified class structure and religious divisions in English society. They represent every level of the working and middle classes and almost every religious denomination. The Crimean nurses also demonstrate every level of nursing knowledge and expertise as well as all the failings of nurses in the 1850’s. This article revises the received wisdom that it was Florence Nightingale and her lady nurses who led the nineteenth century nursing reforms and argues that the working class hospital nurses had a bigger impact on the development of the new nursing. By the mid-nineteenth century nursing had emerged as a serious body of knowledge requiring clinical experience and professional judgement.

This dissertation analyses the work of female nurses in military and naval hospitals from the mid-eighteenth century until the aftermath of the Napoleonic Wars in the early nineteenth century. Nursing history has primarily forgotten these women, or when they do enter into historical narratives, it is often as a foil when compared to the medical practitioner. Pre-Nightingale nurses are often framed by nursing historians as ineffective, ignorant drunkards, the embodiment of the Dickensian Sairey Gamp stereotype. By examining why medical practitioners and naval and military administrators decided to hire female nurses, it is possible to explore two frameworks of investigation in this dissertation. First, the importance of nurses to eighteenth-and early nineteenth-century military and naval clinical hospitals was shown in official correspondence, regulations, and medical treatises. Examining the crucial role of nurses in maintaining a healthy healing environment through cleanliness and ventilation reintegrates nurses into a previously male medical practitioner dominated narrative. In Britain, both patient care and domestic duties were viewed, societally, in the eighteenth and early nineteenth centuries as distinctly female skills. At West Indian stations, the ideal nurses were also female. Yet, the additional layer of race and accompanying theories of racialized immunity to tropical diseases, combined with the stratified labour market of the islands, meant that Black women were considered by medical practitioners to be the best nurses. These considerations resulted in the employment of enslaved women at the Bermuda Naval Hospital. Second, I counter historiographical preconceptions about pre-Nightingale nursing through a detailed prosopographical analysis of the nursing workforce at Plymouth Naval Hospitals, in conjunction with the nursing regulations for military and naval medical systems of care. As the experiences of nurses of Plymouth Naval Hospital show, the physical stability of naval hospitals allowed for nurses to develop healing and care skills over a period of longstanding employment. These nurses were not, as the historiographical prejudice contends, primarily thieves and drunkards. Furthermore, a comparison of military and naval regulations demonstrates that the regulatory structure of naval hospitals, and the position of nurses in them, cannot be explained merely by the permanence of their institutions. Nursing and nurses were part of a broader professionalization of healing practices in the second half of the eighteenth century. As complex institutions, naval hospitals only functioned when everyone’s role in the hospital was clear. In the army, by contrast, the role of nurses was less explicit and not carefully delineated. When recollecting the pre-Nightingale period of nursing, it is often the military nurses who are recalled by nursing historians – women seen even at the time as replaceable, untrained, and unnecessary. Reconfiguring our view to include the naval nurse – valued, crucial to hospital operation, and with a defined role – complicates the long-standing progressivist account of nursing after Nightingale to illustrate continuity between the two periods.

Community nursing and public health work provided many Victorian and Edwardian women with the opportunity of a career and professional training. Such work created contradictions, not least the tension between ‘inherent’ female skills and the role of learnt professionalism. This article will discuss Manchester’s neglected District Nurses alongside the city’s more well-studied health visiting scheme. Comparing these occupations in one city highlights continuities in origins and practice, but a clear divergence in terms of class and purpose. These differences provide historians with opportunities to reconsider the inherent tensions and varied identities of employed women in Victorian and Edwardian Britain

Contents Introduction .......................................................................................................................................................................................... 2 Nursing before Nightingale .................................................................................................................................................................. 4 Nursing in Italy ..................................................................................................................................................................................... 14 Nurses and nursing in hospitals ........................................................................................................................................................... 21 Nursing in wartime ............................................................................................................................................................................... 24 The development of nursing traditions and cultures in Europe ............................................................................................................ 37 Global histories of nursing; internationalism in nursing ....................................................................................................................... 51 Histories of leadership in nursing ........................................................................................................................................................ 58 Florence Nightingale’s contribution to the development of nursing: controversies and debates ......................................................... 65 Histories of nursing practice ................................................................................................................................................................ 71 Italian Day ............................................................................................................................................................................................ 88 Other nursing healthcare related subjects ........................................................................................................................................... 125 Conclusions ......................................................................................................................................................................................... 139 Appendix: Keynote presentations.......................................................................................................................................................... 141 [1] Introduction Dear guests, authorities, speakers, researchers, nursing and health history enthusiasts, colleagues, sympathisers, WELCOME! It is really a great honour to be here to welcome you all to this International Conference in Florence, in this historic building so meaningful for the City, the City where Florence Nightingale – two hundred years ago – was born. It is a great pleasure to welcome you to a Conference that has been thought, planned, and organised in this unique city. I take this opportunity to thank the Nurses Order of Florence and Pistoia as they believed in the goodness of our initiative and actively supported us; I thank the few sponsors who helped us to bear the costs of the organisation, and all the Institutions involved. This occasion is a perfect example of what it means that a dream can become true. I first thought of staging an event in Florence to celebrate Miss Nightingale in 2010. I have been trying to involve the AAHN - American Association for the History of Nursing in 2007, in Yokohama (it was during an ICN Conference). At the International Perspectives in the History of Nursing Conference, held in September 2010, hosted by the Royal Holloway, University of London, at Egham, Surrey, I ended my presentation with an invitation to Florence. Following that Conference the European Association for the History of Nursing was born. In 2010, as CNAI, we succeeded in having our National Annual Conference and a special postmark. However, I did not succeeded in securing any international guests in 2010 as a celebration of Nightingale’s death, so in 2017 I started to think of a Conference celebrating her birth. That year, in fact, I was still CNAI President. With Anna (that is, Anna La Torre, Co-chair of the Conference. I would never thank her enough for her hard work especially in this last year! Thank you Anna!), with Anna we have shared the passion for the history of nursing and have done our best to involve as many people, organisations and institutions as possible in this project. This is not our usual job, and we have been supported by the Symposia staff (and I thank them too for their patient work). I do apologize for any inconvenient that some of you may have encountered in registration, in submitting abstracts or at any other stages of the process. I assure you that we have done our best to find a solution to each problem. I also have to say that we had to use all our “Italian-ness” to be as flexible as possible and find last-minute solutions to misunderstandings, delays, forgetfulness or oversights. In any case: we are here now and, indeed, we are proud of our being Italian! We are more than happy to give you a taste of what Italy has to offer to visitors from overseas. Right now, however, we are eager to start our celebration with experts from 22 countries and I think this point needs a special mention. We have here, in these three days, people from Australia, Belgium, Canada, Chile, Croatia, Denmark, Estonia, Germany, Israel, Japan, Malta, Norway, Poland, Portugal, Slovakia, Slovenia, Spain, Switzerland, United States, United Kingdom, The Netherlands and Italy. We have been astonished by the huge number of requests to participate. We have also reached one of the targets we were hoping to meet: to present a group of experts to enable a network for people sharing the same interests. Our wish had been also to offer to all of you an Italian stamp dedicated to Florence Nightingale. Unfortunately we did not succeeded for today. However, we have been assured that next May a special stamp dedicated to her would be issued. Back home, you will receive a copy if you leave us a mailing address. Another goal we hoped to meet was to make everybody in Florence, in Tuscany, in Italy, in Europe and in the world know that 2020 is the International Year of the Nurse and Midwife. Pope Francis listened to our request (we wrote to Him with other Italian Nurses Associations), and after the Angelus last January he mentioned this special year. More precisely, the reason why WHO and ICN chose this very year to celebrate nurses is because 200 years ago Florence Nightingale (the founder of modern nursing) was born. Her birthplace is not far from this very site in Florence, hence the choice of this venue for today's celebration. The choice of February, on the other hand, was a practical one: Miss Nightingale was born on the 12th of May (this is the reason for the annual celebrations of the International Nurses Day) and May 2020 is going to be a very busy month for every nurse and nursing institution all over the world. And, given that the city of Florence is always crowded with tourists, especially from April to October, we decided to start early: tomorrow is St. Valentine’s day and we liked this too – our Agency Symposia, on the other hand, were a bit less enthusiastic, as they had a hard job finding a restaurant for tomorrow’s social dinner; but we got our reservation anyway! Now, before I introduce my Co-chair Mrs. Anna La Torre for her greetings, a few words to tell you why we do believe it is important to talk about nursing history, to give the floor to historians in the field of health care sciences. I believe that the reasons why women and men of all times have taken care of the poor and the sick are ultimately the same as why nowadays some young women and men enrol for a nursing degree or in a healthcare assistant course or choose a medical doctor's career, or a health care profession in the army. We are people sharing the same values, ideals, and let me use this word: we do love people, humanity, all the suffering and needy women and men. Our identity is entwined with caring values, it is made of the same stuff that moved many women at the very beginning of history to help one another, many nurses in the first centuries AD to help the wounded and the needy, until Nightingale and the advent of the modern caring professions. And what about it now? Are the caring values and ideals of humanity still with us? It is not easy to always answer in a positive way. We do believe that knowing history, studying our roots as nurses and caring professionals can be a great help in preserving these core values, this essence of nursing. This is, in brief, our mission. This is what this Conference intends to support. Cecilia Sironi [2] Winston Churchill once said all great speeches start with great greeting, that why I want to start with the greatest greeting in the world. CIAO CIAO is the most iconic Italian greeting. Whether you are coming or going, flying in or flying out, embarking or disembarking, you cannot escape hearing the word “Ciao!” It is everywhere you go, from Rome to Thailand! “Ciao! Come stai? Ciao how are you?. It is a very small word but powerful. The charming thing about “Ciao” is that it has a lot of personality, and depending on your intonation and how you use the word, It can emphasis friendship, as in “Ciaaaaooooo” …I am so happy were bumped into each other to the more flirtatious, “Ciao bella…” (Hey babe! Do you want to go out with me tonight?”). Using a double “Ciao Ciao” …or even more like “Ciao ciao ciao ciao” translates to “Gotta go. I’m in a hurry!” However, If we analyse deeper the origin of the word, as all nurses and historians do, originally the expression “Ciao” evolved from the Venetian dialect, from the phrase “s-ciào” which means “I am your slave”. Over the course of time the Venetian greeting “s-ciào” was eventually shorted to “Ciao”, and completely lost its servile connotation, but the value of this word remains attractive in all scenarios… I am here for you, I’m at your service It is not a simple welcome. It is my personal wish that these days will be full of cultural exchanges. Human connection is an energy exchange between people who are paying attention to one another. An interpersonal relationship has the power to deepen the moment, inspire change and build trust. In a world full of people, what can be more beautiful than knowing how to form healthy relationships and establish deeper connections with those around us – to feel socially connected, especially in today’s increasingly isolated world. I am here to share with you… , I am here to Know you and to help you….I’m at your service. Have a wonderful time in Florence and… CIAO from my heart to all of you. Anna La Torre [3] The Hospital nursing of Lleida in the 17th century Lorena Lourdes Tejero Vidal1,2,3, Carmen Torres Penella2,3, Francisco Tejero Costa1 HOSPITAL UNIVERSITARIO SANTA MARIA, Spain; 2UNIVERSITY OF LLEIDA, Faculty of Nursing, Spain; 3FEBE, Group for the history of Nursing in Catalonia 1 The hospitals that emerged throughout the middle ages in the city of Lleida were small establishments, with scarce resources and with functions of accommodation and food supply. What made the number of people dedicated to care in them was scarce, and in many cases it was done by couples with the help of servants. The hospital of the Santa Maria had great influence in the entire geographical area that surrounded it since there was none between the roads of Barcelona-Zaragoza, so many people attended it when they go sick. Medical assistance was guaranteed due to the obligation of doctors to visit the patients in the center periodically, exempting them from paying municipal taxes and also receiving remuneration. The aim of the study has been to make visible the nursing in the Hospital of Santa Maria during the seventeenth Century, being the name of “Hospital General de María Santísima dels Angels de Pobres Laichs” the most common at that time. Methodology The methology that has been used for this study is based on the vision of the Annales School, not simplistic and highlights the narration of the events. A double paradigmatic, interpretive and socio-critical perspective has been taken into account, for better adhering to the interest of the study. The social and historical space in which this research study is framed is that of the city of Lleida in the seventeenth Century. The subjects under study were the nursing professionals who worked in the establishment. Data collection has been carried out in two local archives: the Municipal Archive of Lleida and the “Arxiu Diocesa” of the city; used techniques of observation, analysis and documentary interpretation of the files. The regulation for reproduction and documentary dissemination established for each of the archives, and always requesting the appropriate authorizations, has been taken into account for the study files. Results The first Spitalers in the Hospital of the Santa María identified in 1450 were Anthoni Gai and Domingo Bertran (which replaces the previous one when he dies), in charge of cleaning the clothes, having the building clean and attending to both the sick and the poor according to “they are able and know” practical, receiving in return twelve pounds and maintenance. The century was characterized by a large number of male professionals dedicated to nursing care. The identified male professionals dedicated to care at the Hospital de Santa María throughout this period have been 34, of which there were 6 couples. These professionals had diverse denominations, such as those of “hospitalero”, “enfermero”, “enfermero mayor”, “barbero” or “ayudante de enfermero”. The 67% of the nursing staff throughout the study period were male. In the records for the year 1631, it is striking that the first nursing figure that appears is that of Angela Solana, as a nurse who served the establishment at a rate of 7 pounds a year. From that date, both men and women appeared in the documents, developing functions of nurses. In the mid-seventeenth century, the hospital had a male nurse and a female nursing, who received 100 pounds as annual salary. Over the following years, the fact that already married couples who worked in the hospital together, the man who was hired and the woman performed the care by assuming the role of husband. On some occasions, the nurses' salary was complemented by remuneration in kind, as happened in 1679, in which Pere Simon was paid 6 pounds and 4 salaries per month in addition to wheat. Discussion The identified nursing staff who developed tasks, activities or functions at the Hospital of the Santa Maria throughout the seventeenth century, was oriented to meet the care needs of sick and needy people, requiring the support of their superiors and a process of training that trained them. These were people who cared without previous training, based on empirical learning from the experience and observation of other people who cared in the same center. Conclusions: Historically, as some authors already pointed out, nursing and care has been a field of knowledge dominated to a large extent by men. Sometimes, because they are considered fit for their physical abilities, for the knowledge that was deposited in them or even for being considered more "pure". The people in charge of the care f the sick and needy at the hospital of Santa Maria in the 17th were both men and lay women; men being 67% of those identified. The women identified, for the most part, performed care by role delegation and not by having a direct contract. [5] Bibliography 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. Rodríguez Ocaña E. Salud pública en España :ciencia, profesión y política, siglos XVIII-XX. In Granada: Universidad de Granada; 2005. p. 258. Sanahuja P. Historia de la beneficencia en Lérida: La Almoina de la Catedral. [vol II]. In: Ilerdencs I d’Estudis. D mecanoscrita. E inèdit, editor. Lleida; 1944. p. 367. Lladonosa Pujol J. Capítol III. Els carrers de l´antiga moreria i Barrinou de Sant Llorenç. In: Universitat de Lleida, La Paeria. Ajuntament de Lleida, editors. Els carrers i places de Lleida a través de la història. Lleida; 2007. p. 174–83. Tarragó Valentines JF. Hospitales en Lerida durante los Siglos XII als XVI. Aportación monográfica a la Historia de la Medicina en una ciudad de la Corona de Aragón. Anales. Colegio Oficial de Médicos de Lérida; 1975;159–248. Milà Mallafré MD. Algunas noticias sobre el antiguo Hospital de Santa Maria. In: Instituto de Estudios Ilerdenses, editor. Lleida; 1984. p. 9. Bertran Roigé P. Sobre els inicis d´una institució benèfica Baixmedieval: L´Hospital de Santa Maria de la Ciutat de Lleida (1435-1519). In: Universitas Tarraconensis, Facultat de Filosofia i Lletres, Departament de Geografia H i F, editors. Tarragona; 1992. p. 33–52. Tejero Vidal LL. Las Hijas de la Caridad de San Vicente de Paúl en el Hospital de Santa María, la Casa de Maternidad y la Casa de Misericordia de Lleida (1792-1936). Aportaciones a la enfermería. Universidad de Lleida; 2016. Conejo da Pena A. Finançament i administració. Rendes i donacions per als pobres i l´obra de l´hospital al llarg del segle XV. Règim, govern, administració i assitència mèdica. In: Institut d´Estudis Ilerdencs, editor. L´Antic Hospital de Santa María. Lleida; 2002. p. 73–8. Sanahuja P. Historia de la beneficencia en Lérida: La Almoina de la Catedral. [vol II]. In: Institut d´Estudis Ilerdencs, Document mecanoscrit, editors. 1944. p. 900. Tejero Vidal LL, Torres Penella C. La historia del Hospital de Santa Maria de Lleida desde el estudio de sus denominaciones. Gimbernat Rev catalana d’història la Med i la ciència. 2016;65:63–78. Cárcamo Vásquez H. Hermenéutica y Análisis Cualitativo. Rev Epistemol Ciencias Soc. 2005;23:204–16. Aróstegui J. La explicación y la representación de la historia. In: Crítica, editor. La investigación histórica Teoría y método. Barcelona; 2001. p. 275–322. González Morales A. Los paradigmas de investigación en las ciencias sociales. ISLAS. 2003;45(138):125–35. Siles González J. Praxis de la Historia. La utilidad de la Enfermeria en el desarrollo social, científico y profesional. Híades Rev Hist la enfermería. 2000;7:55–89. Siles González J. La investigación en la historia de la enfermería. In: Aguaclara, editor. Historia de la Enfermería. Alicante; 2008. p. 33–84. Sandoval Verea F. Fuentes medievales y modernas de los archivos históricos provinciales españoles para la historia de las actividades sociosanitarias. Temperamentvm [Internet]. 2014;20. Available from: http://www.indexf.com/temperamentum/tn20/t2214.php Conejo da Pena A. Precedents històrics. Tradició hospitalària medieval a Lleida. Naixement i constitució de l´hospital general de Santa Maria. In: Institut d´Estudis Ilerdencs, Diputació de Lleida, editors. L´Antic Hospital de Santa María. Lleida; 2002. p. 53–68. Tejero Vidal LL, Torres Penella C. Las competencias de enfermería en el “Spital de la Ciutat de Leyda” del siglo XV. (1) Las competencias de enfermería en el “Spital de la Ciutat de Leyda” del siglo XV. Temperamentvm 2012, 16. . Temperamentvm. Marí Brull G, Macià Montejano M del C. Les ordinacions de l´Hospital del Coll de Balaguer de l´any 1430. Gimbernat Rev catalana d’història la Med i la ciència. 1992;17:207–12. Dominguez Alcón C. Enfermeros y enfermeras. In: Editorial Pirámide, editor. Los cuidados y la profesión enfermera en España. Barcelona; 1986. p. 52–80. Fargues García I, Tey Freixa R. L´atenció als militars a l´Hospital de la Santa Creu. Segle XVIII. Barcelona Quad d´Historia. 2002;7:249–63. Fargues García I, Tey Freixa R. “Ordinacions de 1417”. Hospital de la Santa Creu de Barcelona. Rev Rol Enfermería. 1997;no 200:47–53. Dominguez Alcón C, Forest M, Sénac R. Evolución de la noción cuidado y la ética del cuidado. Feminización e invisibilización del cuidado. Ética del cuidado. Mirada pluridisciplinar hacia el cuidado. In: Tirant Humanidades, editor. Qué políticas para qué igualdad Debates sobre el género en las políticas públicas en Europa. Valencia; 2013. p. 91–102. Ortiz Gómez T (Aut), Miqueo C, Tomás C, Barral MJ, Fernández T, Yago T (Eds). El sistema sexo-género en salud. El género, organizador de profesiones sanitarias. In: Minerva Ediciones SL, editor. Perspectivas de género en salud Fundamentos científicos y socioprofesionales de diferencias sexuales no previstas. Madrid; 2001. p. 53–75. [6] For nurses the century XVII: "Light of medicine, rational practice, and Methodica, nurses guide, beginner’s directory" António Freitas1, Lucília Mateus Nunes2 1 School of Health, Polytechnic Institute of Setúbal, Portugal; 2School of Health, Polytechnic Institute of Setúbal, Portugal; NURSE'IN, Nursing Unit Research for South and Islands The main change towards the disease at the post-Renaissance period was largely due to the knowledge of anatomy. Disease management and assessment were based on Hippocratic roots in which the reason people fell ill was due to the imbalance between the four temperaments: blood, yellow bile, black bile and phlegm. Fighting illness could be achieve by rebalancing the temperaments, through the administration of remedies made out of herbs and other substances in the nature, but a strong conviction on superstition remained. It’s in this atmosphere that a book appears, aimed not only for physicians but also for nurses. It’s called “Light of Medicine, rational practice, and methodical , nurses guide , beginners directory” [translation from Portuguese], written in Portuguese by the physician Francisco Morato Roma, who had 9 editions between the 17th and 18th centuries and its first edition was in 1664, in Lisbon. Although it’s not a textbook exclusively for nurses, it evokes the importance of nurse’s role. The first edition was in 1664 in Lisbon, followed by eight more reissues. The year 1686 stands out, when two editions of the same book are published simultaneously in two cities: Lisbon and Coimbra. On the edition of 1726, the book was expanded with a surgery treaty. To the original work, throughout the different editions, other treaties and compendiums were added. We can consider this book of high historical value, not only due to the number of editions - 9 editions of which 8 are were posthumous, thus being of great importance in the dissemination of knowledge about diseases and treatments in the 17th and 18th centuries. It was also identified in several Portuguese Apothecaries inventories and in Brazil, through the Order of the Jesuits on that country (Leite, 1953). “Will the curious reader ask me why I moved to do this brief practice in the Portuguese language?” That’s the way Francisco Morato Roma begins his book, in 1664, aimed at “Portuguese-born people, nurses and others who, should not make mistakes in healing the sick as many people do, by wearing a doctor's cap”. The book was wrote in Portuguese, because Latin textbooks reached only the educated elite and due the fact, that, a dead language, like Latin, offers few possibilities for innovation. This linguistic option, allowed, the great acceptance of this textbook, justified by the various editions and reissues. In the prologue to the reader, Morato Roma states that this textbook allows beginners to be aware of Hippocrates and Galen doctrine. As for the nurses, this textbook will allow them how to help the sick in time. The first edition of this book carries a body of knowledge, from the assessment and management of the sick person, but also what we would now designate as Health Promotion: healthy living habits as well as health conservation and the knowledge to prevent diseases, because the most important was to anticipate diseases. In this book, Mourato Roma establishes the limits of the “professionals” in the art of treating the sick, in which the surgeon is responsible for the interventions of “opening”, “cutting” and “sewing” by his hands, to the Apothecaries, the execution and elaboration of syrups and purges and to the Barber, the bleeds. However, fever, which means illness, only the physician has the art necessary to “achieve the health of the sick”. According to the author, this textbook is aimed to everyone in general but specially for nurses who assist the sick, so they will know when to provide the remedies, and for those who live in remote places and who don’t have doctors, they can assist the sick as soon as possible. A surgery book from 1683, said that nurses have to meet four the conditions: “mild”, “peaceful”, “cheerful” and “discreet”. In 1712, the first Portuguese dictionary defines Nurse as "the one who is in charge of the infirmary, and the sick" and in turn defines infirmary as "the place where the sick is healed, in a convent, or in a Hospital”. In the book, the first reference to the nurse's role, places him at the same level as the physician, by identifying signs of illness of the sick, regarding to what he calls the “Vital Faculty”: “if the pulse is small, and accelerated, it shows weakness in the vital faculty. . . The physician, or nurse, who assists the patient, will be able to know by the signs indicated, in what state the patient is in ”(p. 30). The second reference is already in the second part of the book, in which the nurse's responsibility in providing remedies when prescribed: “they must keep the application of remedies in the time, when it is necessary. ”. For Morato Roma, medicine is divided into three parts: Diathetics; Pharmaceutics and Surgery . The diet is considered the most important dimension to maintain health and to restore it to those who have lost it. In this way, curing diseases, that require medical intervention, is always through diet first, then purging and then bleeding. Exercise, rest (quietness), the breathable air, the passions of the soul, evacuations and daily retentions are considered necessary needs to preserve life; however, all of them must be in moderation, in order to preserve health, which the author calls precaution. Those things are called unnatural, as they only depend on the subject's will. The cure of a disease may require the use of iron, fire or medication. Regarding to medication, it may be of two types: interior and exterior. Interior medicines will be those that will be absorbed by the digestive tract, namely syrups and purges. Also included in the interior category are those that introduce liquids, namely enemas and irrigations. External medicines, on the other hand, consist of baths, washes, greases and plasters, that is, all interventions that are applied externally. [7] In order to a better understanding of the disease process, we are presented with the concept of vital faculty, which is what sustains life, and it is preserved through drinking, eating, and other unnatural things. Vital Faculty can be observed if the pulse beats are the same [as the heart], without greater speed than usual and "if there is vividness in the eyes, and a good color in the face ". In maintaining health or, as Morato Roma says, to maintain the vital faculty, food is necessary, since the forces are conserved with eating However, he argues that in the situation of illness, the patient's habits should be changed very little, because “the sudden changes can make a lot of damage”, the habits must be maintained before the disease regarding to sleep, exercise,air, and the daily bowel movements. Still regarding food, it should not only import the quantity, but also the quality As for the ingestion of liquids, he says that they serve to dilute food and to “erase dryness”; this should only be done with water, because it’s not a nutrition. Drinks that are not used as food are used in the medical field, as is the case of herbs boiled in water, herbal juices and syrups. Wine, milk and broths are food drinks. Still regarding wine, it can be drunk diluted in water or pure, for those who are not satisfied with just water. Not only food is responsible for maintaining good health, but sleep, rest and activity. With the recommendation that when the body is tired should rest and after meals should, move because movement “helps in the distribution of food” and “shaking the moods” and is very important for maintaining health. The religious dimension is present throughout the entire book, since its dedication to Holy Mary, allusions to the designs of God as well as in what concerns to venereal diseases, since they result from activities that go against the laws of God. Conclusion Throughout the writings, expressions such as “knowing the customs and habits of the sick and their family” are common, leading us to what we now call the holistic care of individuals and families, in a given socio-cultural context. This is, without a doubt, a predecessor view for personalized health care nowadays. The textbook parts and chapters resembles current medical encyclopedic books aimed at laypeople, on the other hand it gathers information for those who are very familiar with the disease processes. However, on this book, that aims to be a reference based on scientific, knowledge, the transition between superstition, disease and the scientific perspective can’t be established in an exact way. This book portraits a current knowledge from an Era. It’s the first textbook written also for nurses in Portugal regarding medical and health issues Finally, in addition to being an important medical compendium, it exceeds the professional public, as, as the author states in its first edition: “A very useful work , and necessary , not only for the Professors of Art of Medicine, and Surgery, but also for all family men; for the poor and rich people be able to benefit, in the absence of educated doctors ”(Roma, 1753, cover). Bibliography 1. 2. 3. 4. 5. Freitas, A. & Nunes, L.(2017). Para os enfermeiros do séc. XVII: Luz da Medicina, prática racional, e methodica, guia de infermeiros, directoria de principiantes. In Referência, Suplemento, 15 (IV), pp. 78-93. Ferreira, A. (1757) Luz Verdadeira e recopilado exame de toda a cirurgia. Lisboa, Portugal: officina de Joseph Filippe Leite, S. (1953). Artes e ofícios dos Jesuítas no Brasil, 1549-1760. Lisboa, Portugal: Edições Brotéria Machado D. B. (1747). Bibliotheca Lusitana, Historica , Critica , e Cronológica, Tomo II. Lisboa, Portugal: Ofissina de Ignacio Rodrigues Roma F. M. (1686). Luz da Medicina Prática Racional e Methodica, Guia de Infermeiros, Directorio de Principiantes. Lisboa, Portugal: Officina de Domingos Carneyro [8] Nursing before Nightingale: the surprising Sisters of St Bartholomew’s Hospital London, 1660-1820 Alannah Elizabeth Tomkins Keele University, United Kingdom At least five hundred women, probably more, found employment at St Bartholomew’s Hospital between 1660 and 1820. They were recruited as nurses or ‘helpers’ and, if satisfactory, were promoted to being charge of wards as Sisters. This paper will consider the status of women appointed as nurses and later sisters, and the contradictory world they inhabited. A combination of the hospital journals and other sources can be linked for selected women, leading to the conclusion that their working lives were just as likely to feature long tenures, employer endorsement and official recognition as they were to invite alarm, or for their employment to end in disgrace. Nurses before Nightingale carry something of a burden of contempt, being representatives of the ‘unreformed’ occupation known for its untrained status and alleged inebriation. Therefore, this paper takes up Anne Borsay’s instruction, ‘to avoid the historiographical rupture imposed by nineteenth-century reformers to strengthen the case for change, and acknowledge the deeper roots of professionalisation in the Georgian era’. The difficulties of separating sick nursing from other varieties of nurse activity have meant that few historians of women’s work have really tried to get to grips with the topic. As Maggie Pelling has pointed out, there are significant difficulties of identification and definition. Where the only descriptor is ‘nurse’ it is not possible to distinguish between nurses for the adult sick and children’s or nursery nurses, who looked after the young irrespective of their state of health. This is regrettable, given Ian Mortimer’s conclusions about the consolidation of ‘sick’ nursing by the end of the seventeenth century, and has rendered most work on nurses as examples of working women rather woolly for the purposes of health historians. Jeremy Boulton, Sam Williams and Steve King have all shown how the records of parish poor relief can be used to reveal nursing activity at the parish expense, albeit with a focus on what this meant for paupers or for parish policy rather than the reputation of the nurse. Employment of poor women as nurses of the sick poor was relief by other means for women of low skill, limited physical ability, or otherwise restricted earning capacity. The stereotype At first sight, institutional nursing might have looked like a last resort. The hospital offered secure accommodation and a decent wage to women who could tolerate the working conditions. There was certainly hot competition for admission as a nurse or helper at St Bartholomew’s in the 1710s, when the hospital recorded not only the names of appointees but also those of their rivals. Between 1709 and 1717 there were 24 occasions when multiple women sought employment at St Barts. There was an average of five candidates for each vacancy, but some women presented themselves repeatedly to try to get in. Widow Elizabeth Woodrolfe tried six times to be chosen 1713-14, before finally being selected as a helper in June 1715. Were the women keen because they were poor? The family and occupational background of nurses and sisters is difficult to learn, but the evidence indicates a variegated picture: women were not all from impoverished backgrounds, although they might have been in declining circumstances and eager for the work. At the time of recruitment, hospital governors were attentive to the risk of women’s financial vulnerability. From the late 17th century the governors took an interest in where the nurses and sisters were legally settled, requiring all new nurses or sisters to offer security against their future poverty, and from the middle of the eighteenth century the hospital routinely sought settlement certificates to ensure that women recruited from other parishes did not gain a new settlement in St Bartholomew the Less. How did women behave in post? The hospital journals include reference to 142 instances of complaint over the 161 years covered by this research, or an average of less than one problem per year. Approximately 67% of all complaints noticed in the Journals resulted in dismissal. Drink was specified in just 19% of these complaints. Petty embezzling was a constant low-level problem (whether of hospital property or patients’ clothing) and much more prominent among complaints than a tendency to drink. So intoxication was a risk, but was not displayed so regularly or egregiously as might be supposed. A fair-minded historian of the Royal London hospital observed in 1962 that ‘lack of moral sense and insobriety are not incompatible with kindness of heart’. And sobriety had to be weighed against other problems. The example of Grace Porter shows how difficult it could be to balance the requirements of the job against the personalities of the women employed. On 9 January 1751 she was dismissed as the sister of Treasurer ward for rudeness and unkindness to patients. Porter petitioned to get her job back, when the Governors minuted that ‘she was very capable of her business and had always been careful of her patients, but sometimes subject to a violence of temper’. She was eventually sacked in 1755, but the hospital’s dilemma was clear: Grace Porter was could be a decent nurse from the perspective of conducting tasks, but her personality was not necessarily suited (or became increasingly unsuited) to patience and caring. Surprising sisters The hospital developed a sense of duty and pride towards the women as their tenure at the hospital lengthened, and their value to the institution was confirmed. It was usual for women to be promoted to the role of sister within three years of first appointment. The average length of employment with the hospital, when this can be calculated, fell between eight and nine years. Generalised endorsement of the hospital’s female servants was rare. Only one instance has been found so far: a minute of 1747 reported that ‘There being no complaint made of any misbehaviour of the Sisters or Nurses of this Hospital your committee is of the opinion that the Sisters and Nurses have done their duty’. [9] Individual reward was possible, wherever the hospital was willing to give selected Sisters a pension, to sustain them from the time they left their hospital service until their death. Lettice Dyne was given a pension of £10 a year in 1721 following her 33 years of employment. From 1784 onwards, some Sisters who grew frail and unsuited to working on the wards were given pensions of sixteen guineas per year for the remainder of their lives. Recognition within the hospital was reflected in a diluted way when women stood at the boundary of the hospital, or went out of their ward to engage with the wider metropolitan world. In this capacity they acted as the conduits for information. For example: the Refuge of the Destitute was a charity which aimed to offer poor men and women a fresh start in life from the first decade of the nineteenth century. Sisters of St Bartholomew’s became instrumental to the charity when they recommended patients or friends of patients to apply there for relief. Illustrating this point, in 1813, seventeen-year-old servant Elizabeth Brill was caught in an act of petty theft from her employer. She attempted suicide by cutting her throat, was taken to St Bartholomew’s, and recovered. At the time of Brill’s discharge from hospital, the Sister of Aldred ward took Brill to the Refuge in person to testify to her good conduct during her time in the hospital. Similarly women were called upon to testify in cases where a suspicious death resulted in a trial for murder, and their word could be influential. Sister Horton sat up for most of the night on 24 August 1737 with her patient William Reynolds. Reynolds had intervened in a street fight, during which a knife was thrown and he was stabbed . He was taken to St Barts and lingered for about 24 hours before he died. William Runnington was prosecuted for Reynolds’ murder, and a number of eye witnesses testified to his responsibility for the wound. The charge of murder was contested, though, on the grounds that the men were ‘like two brothers’ and that the knife was used in ‘heat and passion’ not ‘malice’. Mrs Horton’s testimony contributed materially to this defence, because she reported that Reynolds had exonerated the defendant: Runnington was acquitted. Reappraisal of the pre-reform nurse This paper has given a different picture of London’s hospital nurses than the one usually offered. Instead of prioritising the frequency of dismissals for drunkenness – and clearly there were some – it has instead focussed on instances where women were regarded as a hospital responsibility, and given rewards for long service or recognition for trustworthiness. The women emerge from this account as individuals with skills and preferences rather than as members of a problematic stereotype. Bibliography 1. 2. 3. 4. 5. 6. 7. A. Borsay, ‘Nursing 1700-1830: Families, Communities, Institutions’, A. Borsay and B. Hunter (eds), Nursing and Midwifery in Britain since 1700 (Basingstoke: Palgrave, 2012) J. Boulton, ‘Welfare systems and the parish nurse in early-modern London, 1650-1725’, Family and Community History 10:2 (2007) A.E. Clark-Kennedy, The London (London: Pitman Medical, 1962 P. King (ed.), Narratives of the Poor in Eighteenth-Century Britain, volume four. Institutional Responses: the Refuge for the Destitute (London: Pickering and Chatto, 2006) S. King, Sickness, medical welfare, and the English poor, 1750-1834 (Manchester: Manchester University Press, 2018) I. Mortimer, The Dying and the Doctors (London: Royal Historical Society, 2009) M. Pelling, The Common Lot. Sickness, medical occupations and the urban poor in early modern England (London: Longman, 1998) S. Williams, ‘Caring for the sick poor: poor law nurses in Bedfordshire, c. 1770-1834’, P. Lane, N. Raven and K. Snell (eds), Women, Work and Wages, c.1650-1900 (Woodbridge: Boydell, 2004) [10] Nursing in Italy: Barbers in hospitals in Spanish Italy (XVI-XVIII) Francisco Glicerio Conde-Mora, Juan Manuel García-Cubillana, José María Montero-Carmona University of Cádiz, Spain In this work we will analyze the evolution of Barbers in Spanish Italy during the Modern Age, between the 16th and 18th centuries. We will show the evolution of their techniques in the viceroyalty hospitals of Naples, Sardinia, Sicily and Milan. We will study the typology of diseases, the sicks, that had to face the barbers in these hospitals of the Spanish empire in the Spanish Italy of the Modern Age. Barbers in these hospitals of Spanish Italy often served as surgeons or dentists. They were medical practitioners, working in these hospitals extracting teeth, cutting hair and performing surgery. We found many unpublished documents in Spanish Historical Archives such as Simancas and the National Historical Archive. We also find unpublished documentation in the Archives of ancient spanish viceroyalties of Italy in which the Barbers exercised their job in these italian hospitals. Bibliography 1. 2. 3. 4. 5. General Archive of Simancas National Historical Archive of Spain Cosmacini, G. (2016). Storia della medicina e della sanità in Italia: dalla peste nera ai giorni nostri. Gius. Laterza & Figli Spa. Manconi, F. (1999). La peste en Cerdeña a mediados del siglo XVII: cuestiones demográficas y sociales. Obradoiro de historia moderna, (8), 121-134. Musi, A. (2000). L'Italia dei viceré: integrazione e resistenza nel sistema imperiale spagnolo (Vol. 16). Avagliano. [11] The nursing care in San Francesco Grande Hospital in Padova. Adriana Negrisolo CNAI (Consociazione Nazionale delle Associazioni Infermiere/i), Italy The hospital of San Francesco Grande in Padua, began to operate around 1440, the first stone was laid in 1414 by initiative of two wealthy paduan spouses, Sibilla and Baldo de' Bonaffari, who driven by christian sentiments of altruism, wanted to offer their contribution to the improvement of the conditions of the poor and needy paduan peolple. When it was made the hospital of San Francesco was not the only one in the area, as it is know that at the beginning of the fifteenth century, approximately 20 hospital were functioning .These were structures of modest size, with limited accomodation approximately 10-20 beds , with a rater rudimentary organisation, in which the charitable ideal prevailed. The history of San Francesco hospital is very important for the relations with the Paduan School of medicine , where the teachers made important observations and descriptions of the human body, that spread in Italy and throghout Europe. The sixteenth was the century of most intense development for the University of Padua and for the hospital of San Francesco, where practiced medicine: Giovanni Battista da Monte, who introduced the lesson to patient 's bed, Andrea Vesalio who revolutionized anatomical practice, Gabriele Falloppio who made important contributions to the development of anatomy, including the descriptions of the uterine tubes, Girolamo Fabrici d' Acquapendente, who held the chair of anatomy and surgery in Padua, identifying new surgical techniques. Furthmore, in Padua in the same years the Botanical Garden, was born which with the study of medicinal plants, allowed the development of botany. However, despite the progress of medical science, the notions of hygiene and those relating to the spread of infections were still inadeguate, therefore the risk of the spread of infections diseases and wound infections was still very high. In In the sixteenth century, the assistance at San Francesco that it was supposed to hospitalize about fifty patients for day, was carried out by adoctor, by a surgeon who also performed dermatologist functions, by abarber, by a man nurse for the men's ward, assisted by 4 nursing assistant, and by a sister nurse in the women's ward.Later at the beginning of the seventeenth century two other figures appeared: the assistant doctor and the medegoto. That of assistant doctor was a position held by students of the last years of medicine or by young graduates, while the medegoto was the assistant of the surgeon. Whith respect to nurse, the documents analyzed, show that since the birth of San Francesco, there was a man nurse for men and a mother nurse for women, the fact that she was defined as a mother suggest that she could be a religious. In the seventeenth century scams and cheating were discovered, followed by numerous layfoff. As result of these events, in attempt to renew the organization, the wages were increased and more stringent rules were introduced about expenditure and the movement of people within in the hospital. This led for about one century to an overall improvement in the management and organization of the hospital. the staff regulations "Ordini e capitoli per il governo dei poveri nell'ospedale di San Francesco" dates to 1648, in the same the task of all those who worked at San Francesco are described in sufficient detail. From this document it emerges that the nurse had the task of: • • • • • • • Write down the general information about: name, surname , country and what the person brought with him, to keep it and return it to him once he was cured or give it to a prior in case he died. Take into account the linen. To give the therapy "With charity, within the time established by doctors, observe their reactions and help them communicate about their disease". To ensure that anyone dies without the Blessed Sacraments. Verify that nursing assistant do what will be commanded, that was to help the sick in their needs, maintaining the infirmaries clean, making the beds every day and bringing water to wash them. Be present in the infirmaries when doctor visit the patient , to take order.They had to be informed about patient's sickness. Be careful that nothing was taken away. From this description some conclusion can be drawn: The nurse had to be able to read and write, if among their duties there was also that of recording patient's personal data, contrary to what reported in other pubblications, according to which nurses until the mid-nineteenth century were illiterate. The nurses didn't take care of the patient alone, they were helped in this by nursing assistants, and nurses had the task of ensuring that they did their duty. They administred drugs and had administrative and coordination duties "The nurse should be assiduous in the infirmaries, and especially during the visit of the doctor to take orders which will be necessary ,and to ensure that it is punctually performed by those who must". However keeping in mind that, the reality could was very different from that described in the document "Ordini e capitoli per il governo dei poveri nell'Ospedale di san Francesco", from this document emerged , considering the times, the existence of a nurse who was quite advanced in term s of care: this contrasts with a certain opinion widespread in the context of historical research in healthcare, that describes the nurse of that period as belonging to marginalized or even infamous social classes, dedicated to drunkenness, prostitution, robberies and in general to bad reputation. However, to avoid incurring superficial generalizations, it should be remembered that the San Francesco hospital in that time, was not the only hospital to provide assistance, about twenty other hospital were active in the city and fifteen others in the Padua area. Therefore we don't know if that has just been described was widespread in other hospital, or if it was only a characteristic of the hospital of San Francesco which, placed under the protection of the Franciscan Order, certainly had pity and assistance of the poor one of its primary purpose, certainly able to influence the actions of those who managed and dealt directly with assistance. This historiographic research presented us from 1600, a nurse with their specific field of intervention and although we cannot say with certainty what knowledge they had , the documents transmitted an image of a nurse who was required counting skills, medical notions, sweetness and charity. Bibliography [12] 1. 2. A. Negrisolo, La memoria del prendersi cura a Padova,Cierre Grafica, 2018 Archivio di Stato Padova (ASP) Ufficio di Sanità(US)146, Ordini et capitoli per il governo delli poveri dell'Hospedal di San Francesco di Padova, MDCXLVIII. [13] Italian Nurses in the Crimean War Carol S Helmstadter University of Toronto, Canada Florence Nightingale’s brilliant achievements in the Crimean War, in the face of opposition from all sides have overshadowed the achievements of other nurses in the other four Crimean War armies. This paper describes the nursing service in one of those armies, the Piedmont-Sardinian army, which I argue was better than that in the British and French armies. Britain and France declared war on Russia in March 1854; Piedmont-Sardinia entered the war later -- their troops did not land in the Crimea until May 1855 -- but they played a key role in the Battle of the Tchernaya and in the final successful assault on Sevastopol. A few years after the Crimean War Piedmont-Sardinia would lead the unification of Italy but in 1855 it was a small kingdom consisting of parts of what is now southeastern France, the western part of the Italian Piedmont, and Sardinia. The Sardinian army was modelled on the French army and the Daughters of Charity of St. Vincent de Paul provided the nursing for both armies. They had come to Sardinia in 1833 to take charge of some of the military and civilian hospitals. Previously, as in British military hospitals the orderlies who were supposed to do the nursing consisted of men commandeered from other army units whose officers sent their worst soldiers. Even with the most rigid discipline these men made very poor nurses who neglected their patients. However, once the Sisters took over the hospital became a model hospital. Founded in 1633 by St. Vincent de Paul, the Daughters formed an international and highly centralized order with its headquarters in Paris. The Sisters were carefully schooled as nurses in their local convents and also trained in what they called ‘exquisite charity,’ meaning treating everyone with respect and courtesy –- good manners including good table manners. On finishing their novitiate Sisters who were proficient in nursing were sent to the mother house in Paris for more advanced training and also to give them a better sense of their order’s transnational mission and the spirit of the sisterhood. The order signed contracts with civilian and military hospitals which, in return for a fixed sum of money, gave them complete control of the pharmacy, housekeeping, and kitchens as well as the nursing. The Sisters themselves, not the doctors, prescribed the diets for the patients. These Sisters had been breaking the gender barrier which forbade women to work in army hospitals since the seventeenth century. Some historians argue they were able to do this because their vows ‘unsexed’ them. Even if that is true, their vows did not completely unsex them because their rule forbade them to give some parts of physical nursing care to men. For example, they could not undress a wounded soldier. This rule made the Sisters’ excellent hospital administration highly dependent on a corps of soldiers who were specially trained as nurses. Many soldiers bled to death on the battlefield when they could have been saved if someone had been there to stop the bleeding. These soldier nurses did exactly this –- they went out on the field under fire, administered first aid and then brought the wounded back to a field hospital, thus saving many lives. All soldier nurses had to be literate because it was they who wrote down the doctors’ orders and patients’ medical histories. They worked in base hospitals as well as on the field. The army gave them additional pay and opportunities for promotion but in the French army, promotion only extended through non-commissioned ranks, something which leading French doctors very much regretted. Because nursing was traditionally associated with women for whom it was then believed nursing was an innate, inherited feminine characteristic, gender adversely affected recruitment. Few recruits volunteered to be nurses –-they wanted to be fighting men -- so most nurses were assigned to the nursing corps by the recruiting officer. The Sardinian army improved on the French army by awarding some soldier nurses officer status, giving an important incentive for new recruits to join the nursing corps. Although most were unwilling nurses at first, these men became highly professional nurses, taking on a major amount of the doctors’ work such as minor surgery and dressings. The doctors were highly dependent on these trained nurses but always complained bitterly that there were too few making it necessary to recruit additional men by the old system of commandeering untrained men from other branches of the army. The first party of Sardinian nurses to arrive in the Crimea consisted of 451 trained soldier nurses of whom 19 were officers, and 28 Sisters of Charity who supervised and coordinated them. Because the doctors kept asking for more Sisters were sent making a total of 67 Daughters who served in the war. The British government, which in round figures sent 100,000 men to the Crimea, sent 225 female nurses for them. The Sardinians obviously took caring for their sick and wounded more seriously because they sent an 18,000 man army more than ten times the number of nurses per soldier. The Sisters were carefully selected and had to have had training in military hospitals – training in civilian hospitals was not considered adequate -- and each Sister had to be able to read and write in both Italian and French. At first there were some problems with theft and misconduct among the soldier nurses but the Sardinian Daughters had an outstanding and very gifted superintendent, a Florentine aristocrat, the Countess Cordero, who soon had all in hand. She would become a close friend of Nightingale who spoke of her ‘with the warmest affection and respect.’ Nightingale and the French doctors found Cordero’s hospitals exemplary. The Sisters cared for the critical cases themselves, fed those unable to feed themselves, and cheered the desponding with their gaiety. They were always noted for their gaiety -- indeed St. Vincent counseled them to ‘greet the sick with a modest gaiety’ when he was training the first Daughters in 1642. The Sardinian hospitals were ‘perfectly equipped and administered,’ the chief French doctor, Dr. Gabriel Scrive, reported. In the wards, in the kitchen, in in the pharmacy, in the housekeeping, -- everywhere in the Sardinian hospitals, Scrive said, there was an intelligent and devoted Sister in charge. And their food was excellent because they were very good cooks and went every day to the market in Balaclava to buy fresh provisions, a very different system from that in the British army where the army kitchens cooked only soup, meat and potatoes. British doctors then prescribed what they called ‘extras’ for individual patients which the nurses and orderlies cooked -- jellies, wine, eggs, rice pudding, and so on, but never fresh produce. The Daughters’ humanitarianism was also outstanding: they treated Russian prisoners whom they put in the same wards with their own wounded, with the same care and kindness, something the British did not do. They kept the Russian prisoners in separate wards and treated their own soldiers first.’ The French Daughters worked only in base hospitals in Constantinople, and never went to the Crimea. The British nurses did go to the Crimea but there they worked only in base hospitals. The Sardinian Daughters were more daring: they worked in the field hospitals. Gerolamo Induno, a hero of the Resorgimento, painted a famous picture of the Battle of the Tchernaya. Induno actually fought in the battle so we know the military details in his painting are accurate. In the center foreground he placed General della Marmora, the chief [15] Italian general, looking over the battlefield; in the right foreground is a unit of horse artillery, then a major key to successful battlefield tactics, and in the left foreground, given equal importance with the horse artillery, are two Daughters of Charity treating a wounded soldier while a wounded Russian prisoner waits his turn. In conclusion, the Sardinian soldier nurses could become officers, there were more than ten times as many Sardinian nurses per soldier than in the British army; the Sardinian Sisters and soldier nurses were far better educated than the working-class British nurses, most of whom were at best semi-literate; the Daughters did not differentiate between their own wounded and enemy wounded; they provided a very superior diet; they broke gender barriers for both men and women; and most important, the Sardinian Sisters and soldier nurses worked on the battlefield where they could save more lives while the British and French female nurses worked only in base hospitals. It is therefore fair to say that the Sardinians significantly improved the French model and provided a far more effective nursing service than did the British. Bibliography 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. Archives of the San Salvario Convent of the Daughters of Charity, Turin, (hereafter San Salvario Convent), ‘Rules of the Sisters of Charity 1842.’ Colli, Giuseppe, ‘L’Organisaton Sanitaire du Corps Expéditionnaire Sarde en Crimee’ Revue Internationale du Croix Rouge,’ Geneva, October 1955. Notice des Soeurs Défuntes 1894-1896. Baudens, M. L., La Guerre de Crimée: Les Campements, Les Abris, Les Ambulances, Les Hôpitaux, etc. etc. (Paris: Michel Lévy Frères, 1858). Bridgeman, Mother Francis, ‘An Account of the Mission of the Sisters of Mercy in the Military Hospitals of the East’ in Maria Luddy, ed., The Crimean Journals of the Sisters of Mercy 1854-56 (Dublin: Four Courts Press, 2004). Chenu, Jean-Charles, Rapport au Conseil de Santé des Armées sur les Résultats du Service Médico-Chirugical, (Paris: Wiesener, 1865). Helmstadter, Carol, Beyond Nightingale: Nursing on the Crimean War battlefields (Manchester: University of Manchester Press, 2020). Jameson, Anna, Sisters of Charity, Catholic and Protestant and The Communion of Labor (Boston, Ticknor and Fields, 1857. Jones, Colin, The Charitable Imperative: Hospitals and Nursing in Ancien Régime and Revolutionary France (New York: Routledge, 1989). La Torre, Anna and Lusignani, Maura, ‘Nursing in the Sardinian-Piedmontese Army during the Crimean War’ in Professioni infermierristiche, Vol. 66, October -December, No. 4. Longmore, Surgeon-General T., A Manual of Ambulance Transport, (2nd edn, London: Harrison & Sons, 1893). Montaudon, General Jean Baptiste, Souvenirs Militaires: Afrique – Crimée – Italie (Paris: Librairie C.H. Delagrav, 1898. National Archives, Turin, Ministry of War, Administrative Services: Hospitals Section, No. 9628. Nightingale, Florence, ‘Introduction of Female Nursing into Military Hospitals,’ in Lucy Ridgely Seymer, ed., Selected Writings of Florence Nightingale, (New York: Macmillan, 1954). Pincoffs, P., Experiences of a Civilian in Eastern Military Hospitals, (London: Williams & Norgate, 1857. Rappaport, Helen, No Place for Ladies (London: Aurum Press, 2007). St. Vincent de Paul, The Conferences of St. Vincent de Paul, (transl Joseph Leonard, 4 vols, Westminster MD: Newman Press, 1952). Scrive, Le docteur G., Relation Médico-Chirugical de la Campagne de l’Orient (Paris: Victor Masson, 1857). Slade, Rear-Admiral Sir Adolphus, Turkey and the Crimean War: A Narrative of Historical Events, London: Smith Elder, 1867). Wellcome Institute Ms 8997, Nightingale to Lady Canning, 23 November 1856, Letter 11. [16] The nursing innovations of St. John of God according to the first constitutions of the Fatebenefratelli Religious Order Elisa Rebosio1, Maura Lusignani2 Ospedale Sacra Famiglia Fatebenefratelli, Italy; 2Università degli Studi di Milano, Italy 1 Introduction Hospitals, in the mid 16th century were owercrowed by poor people which caused a progressive decay of functionality. The hospitalized conditions were aggraved by the poor hygiene of places and people, in fact the hospital mortality was about 90%. In 1500, the decisions of the “Council of Trento”, lead to aseculirization of the personnel, who were recruited in the poorer sectionsof the population: ex prisoners, ex prostitutes, alcoholics, poor people without any specific preparation. St. John of God, founder of the “Fatebenefratelli”, is located in this historical period of decline of assistance. St. John of God personally experienced the patients treatment in Hospitals of the time, understanding the need for a Reforme of Care. Juan Ciudad was born at Montemor-o-novo in Portugal, in 1495.When he was eight years old, he left for Spain with the Cleric who had spent the night in his home, and stayed at Oropesa (Toledo) working at the service of the home of Francisco Mayoral. Until 1538 he performs various activities: pastor, soldier and book seller. In 1537, attended a sermon by St. John of Avila, that provoked him such a mind disturbance that he started running through the streets and throwing himself on the ground asking for forgiveness from the Lord. He destroyed his bookshop and continued acting strangely in this manner for several days until, cosidering him to be out of his mind, he was locked up in the Royal Hospital of Granada. He left a few months later, completely calm, at peace with himself and ready to follow the Lord, by offering himself to serve others. He placed himself under the Spiritual Direction of St. John of Avila, went on pilgrimage to the Shrine of Our Lady of Guadalupe and, on his way home, he passed through Baeza, where he spent some time with the King of Spain. Just returned to Granada, he began his work of caring for the sick and needy poor. He founded his first Hospital, The House of God, where there was room for everyone. He started with absolutely nothing. In the development of the work of St. John of God, alms and the benefactors are particulary important. In order to raise the money to provide for the poor, he went out on the streets carryng a duffle bag on his shoulders and two pots in his hands and aloud he used to say: “Brothers, do good to yourselves, do well for God’s sake, my brothers in Jesus Christ”. It is from this phrase that born the name “Fatebenefratelli”. He died in 1550, without leaving written rules, but his examples were such that his Brethren continued to assist the needy acccording the Principles of the Saint. The main innovations in the Home of St. John of God were: - One sick in one bed - Appropriate diet - Division of the sick into categories - Work House - A ventilated room for infectious diseas - A ward for abandoned babies - An Hospice, where poor and moneyless travelers could sleep. The Hospice was a large room that could accomodate up to 200 people, who were provided with fire, food and beds. Today this innovations are normal, but, at the time, were revolutionary. The style of care of St. John of God was also new, anticipating the times, he was able to offer a global assistance, putting the patient at the center of care. Aim The purpose of the research was to identify the nursing innovations introduced by St. John of God in the period 1538 – 1596 and to determine, if and how, they are related to current nursing pratices. The method has been a bibliography search. The first Constitutions of the Order (1585 – 1587 – 1596) have been analyzed. For each document the actors of assistence, culturally significant acts and Charisma have been identified. [17] Results In 1571, the “Fatebenefratelli” were recognized as a Religious Community, according to the Rule of St. Augustine and profess the vows of poverty, chastity, obedience and to assist the sick. In 1586 they were recognized as a Religious Order. There were 25 Hospitals managed at the time. The first written Constitution was that of 1585, valid only for the Hospital of Granada. The first Constutution of the Order dates back to 1587, revised in 1589 and 1596. The Constutions are divided into chapters. In the first part is descripted the “Rule of St. Augustine”, in the following chapters is described the Organization (General rules). The last chapter is dedicated to the assistence (Hospitality), in which is described as help the needy. It’made up of 8 articles: - Of the order to keep the poor sick in bed - The way in wich the Doctor and the Cerusico will have to visit the sick - On the order of how to feed the sick - Of the Guard, both day and night, which must be done in our Infirmaries and the way to keep the poor sick discharged …… etc - Of the great care we must have for the sick who are in the agony of death - Of the “Spiritual Exercises” that are done in our Infirmaries - Activities of “Infermiero Maggiore” - Activities of Cloakroom. The “Chapter of Hosptality” begins with the description of how to put the sick to bed (27): “ … the infirmary will receive them with all lovingness, he will wash them and dress them and, if necessary, he will warm the bed …… “ We can relate this to the reception of the patients in our Hospitals, to take charge of the Person as a whole and to put the patient at the center of care. “The book of the sick” was compiled, comparable to our “Hospitality Registration”. It continues with the description of “How to feed” (29) “... the major nurse will give the food living each one everything that the doctor will be ordered, by reading a brother the book where the eat was written, and the nurse will take care of those who can not eat for themselves to send you a brother who servant....” “..the major nurse after of having started eating will go visiting the sick one by one asking them if he was given everything that the doctor was ordered..." It is possible to see the Nursing care process in satisfying the need for feed. We therefore understand the importance of an appropriate diet and personalized menus, according to the needs of Patients. In article 30 of the Constitutions it is highlighted that the Nurse assist the Patients day and night, ensuring continuity of care. It i salso stated, in the case of a convalescence period it becomes necessary, the Patients will be transferred to Hospitals with adequate facilities. We can therefore say that a distinction between “Acute Care Hospitals” and “Riabilitation Hospitals” is clearly visible, related to what is described in the current continuity of care and relations with the territory. In Article 28of the Constitution we can distinguish the various Professional Figures in the Hospital, and also in this case, we can see a correlation with what, in current pratices, we define “Multidisciplinary Team”. It is established that the Patient will be visited twice a day by the Doctor, together with the Cerusico, the Barbiero, the Spice and the nurse, distinguishing the various Professional figures in charge of the visit. Particular attention was dedicated to listening to the needy. The prescriptions were noted in Notebooks, comparable to the current “Patient record”. The article 35 describes the activities of cloakroom attendant, he took care of the linen of the confreres and patients. Every today, inside my Hospital, the cloakroom service takes care of patient linen. Even death, although sad in its reality, it’s an obligatory step and occupies a space within the Constitutions. The article 31 describes the accompaniment to a serene death and Religious assistance. Still current topic. The article 34 describes of the activities of the Infermero Maggiore, comparable to the current figure of the Nurse Manager. - Attention in the execution of medical therapies - Coordination of domestic-hotel activities. With particolar attention to the hygiene of the premises and patients - Human Resources management: It had to guarantee the presence of nurses both during the day and during the night - Management of Material Resources: Treatment of medicines, control of Nurses and coking. [18] Conclusions The bibliographic showed that it is possible to state that the nursing innovation introduced, can be related to some current nursing practices. Bibliography 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. Dimonte V. Da servente a infermiere. Torino: CESPI;1993 Martellotti E. (a cura di). Per una storia dell’assistenza infermieristica in Italia, Atti I° Congresso nazionale di storia dell’assistenza infermieristica in Italia. Federazione Nazionale Collegi IPASVI; 11 giugno 1993 Reggio Emilia, Passera O. Assistenza infermieristica. Storia sociale. Milano: CEA;1993 Pazzini A. L’ospedale nei secoli. Edizioni Orizzonte Medico:1958 Armocida G Zanobio B. Storia della medicina (2ed). Milano: Masson; 2002 Manzoni E. Storia e filosofia dell’assistenza infermieristica (1ed). Milano: Masson; 1996 de Castro F. San Giovanni di Dio. Vita e Opere, Milano: Ed. Fatebenefratelli;1989 oh Magliozzi G (a cura di). San Giovanni di Dio narrato dal Celi. Milano: edizioni Fatebenefratelli; 1993 de Villethierry J G. Vita di San Giovanni di Dio fondatore dell’ordine dell’ospitalità. ed. in Firenze; 1747 oh Magliozzi G. Un messaggio per Giovanni di Dio dalle mazmorras di Granada. Il Melograno Taccuino virtuale Giovandiano, Provincia Romana dei Fatebenefratelli 2012, anno XIV n.3 oh Magliiozzi G. In che mese si convertì San Giovanni di Dio. Il Melograno Taccuino virtuale Giovandiano, Provincia Romana dei Fatebenefratelli 2012, anno XIV n.8 Balzarini C, Bruziches D, Mauti R. Lo stile assistenziale di San Giovanni di Dio ieri, oggi, domani. Milano: Ed. Fatebenefratelli; 1998 Leone S. L’etica in San Giovanni di Dio, Commissione Generale di Bioetica. Roma: Ed. Fatebenefratelli; 2012 Carta d’identità dell’Ordine. L’assistenza ai malati e ai bisognosi secondo lo stile di San Giovanni di Dio. Roma: edizioni Ordine ospedaliero di San Giovanni di Dio Fatebenefratelli; 2004 Pazzini A. Assistenza e ospedali nella storia dei Fabenefratelli. Torino Ed. Marietti; 1956 Autori Vari. Lo stile assistenziale di San Giovanni di Dio. Roma: edizioni Fatebenefratelli; 1998 Bellido J F. Giovanni di Dio “folle” per amore. Roma: Città nuova; 1995 San Giovanni di Dio e Camillo de Lellis, ed. Fiorenzo Angelini Russotto G. Le costituzioni dei Fatebenefratelli del 1596. Roma: edizioni dell’ufficio formazione e studi dei Fatebenefratelli;1964. Russotto G. Contributo dei Fatebenefratelli allo sviluppo ospedaliero; Atti primo congresso italiano di storia ospitaliera; 1956 giugno 14-17 Reggio Emilia; p.630-637 Briacca G. Charitas e scientia nel primo secolo di cronaca del “Melograno” 1588-1687. Milano: Edizioni Fatebenefratelli; 1992 Francini M. Fatebenefratelli - S. Giovanni di Dio e i suoi seguaci in Italia.Milano: Frassinelli, 1985 Costituzioni dell’Ordine Fatebenefratelli 1585 Costituzioni dell’Ordine Fatebenefratelli 1587 Lettere di San Giovanni di Dio a Gutierre Lasso, a Luigi Battista, alla duchessa di Sessa [19] Nightingale’s “linchpin”: Ward sisters, head nurses, and the quality of hospital nursing care by nursing students and attendants in the UK and USA between 1920 and 1949 Sheri Tesseyman Brigham Young University, United States of America Abstract Background: During the nineteenth century and much of the twentieth century student nurses and minimally trained attendants provided most hospital bedside patient care in the USA and UK, supervised by head nurses and ward sisters (Bradshaw, 2001; Reverby, 1987). Florence Nightingale believed that the ward sister role was the "linchpin" or "keystone" of hospital patient care (Nightingale & McDonald, 2009). Without a strong ward sister, nursing care could not be effective This study aims to explain the development and implications of supervision of students and attendants in hospitals in Britain and America from the 1920s through the 1940s, when transitions from hospital patient care by students to graduate nurses and nurse education from hospitals to institutions of higher learning developed in America. Nurses in Britain observed with great interest. Methods: A comparative method was chosen to reveal factors that might be overlooked in a study of one country alone. Primary sources for both the UK and the USA include professional nursing journals and books from archives in the USA and UK. Findings: Various professional and social factors in the USA led to appeals for graduate registered nurse service to replace student nurse service in hospitals. Poor quality bedside care provided by students was cited as one factor. In Britain, however, bedside care by students was considered to be excellent. Roles of head nurses in the USA and ward sisters in the UK differed. Head nurses in the USA were often senior nursing students with little supervisory experience and the modest prestige of an advanced student. Helen Boyleston's (1936) depictions of student nurse life in the 1930s illustrates the uncertainties and challenges experienced by senior student head nurses. After one year, the senior student head nurse would graduate and a new senior student head nurse would be appointed. In the UK, on the other hand, ward sisters occupied a permanent position in hospitals and enjoyed a high level of respect and prestige. They had the means to develop advanced supervisory skills. Discussion and conclusion: Differences in supervision of student nurses in the USA and the UK, particularly regarding the ward sister role in the UK, which Nightingale called the “linchpin” or "keystone" of her plan for hospital nursing, and the head nurse role in the USA may have contributed significantly to differences in the quality of bedside care—with fundamental implications for the future of nursing in each country. Bibliography 1. 2. 3. 4. 5. 6. 7. 8. Secondary sources Bradshaw, A. (2001), The Nurse apprentice, 1860-1977, Aldershot, England: Ashgate. Nightingale, F., & McDonald, L. (2009). Florence Nightingale: The Nightingale School : Collected Works of Florence Nightingale, Volume 12. Wilfrid Laurier University Press. Reverby, S. (1987), Ordered to care: The dilemma of American nursing, 1850-1945, Cambridge: Cambridge University Press. Primary sources Boyleston, H. (1936), Sue Baton, student nurse, New York: Little, Brown, and Company, Private collection. Boyleston, H. (1936), Sue Barton, senior nurse, New York: Little, Brown, and Company, Private collection. Trained Nurse and Hospital Review, v. 64 (1920) - v. 122 (1949), Baltimore, Md.: Joseph Kruger, Royal College of Nursing Archive, Edinburgh. Nursing Mirror and Midwives Journal, 1920-1949, Royal College of Nursing Archive, London. [21] A Sightseeing Over the Illusion: the Portuguese Nurses and the Alienated at the End of Nineteenth Century Analisa Candeias1,2,3,4,5, Luís Sá4,5,6, Alexandra Esteves7,8 1 University of Minho - Nursing School; 2UICISA-E (Core UMinho); 3PhD Student: Catholic University of Portugal - Institute of Health Sciences; 4Centro de Investigação Interdisciplinar em Saúde (CIIS); 5Sociedade Portuguesa de História de Enfermagem; 6Catholic University of Portugal - Institute of Health Sciences; 7Catholic University of Portugal - Faculty of Philosophy and Social Sciences; 8 Laboratório de Paisagens, Património e Território (Lab2pt) - University of Minho Nurses, in Portugal, crossed significant moments of transition in the passage from the 19th century to the 20th century. However, it was at the end of the 19th century that the portuguese nurses began to be distinguished as fundamental agents in the assistance of the alienated at psychiatric hospitals. This century, in the country, was fruitful in establishing spaces for the assistance of the alienated: by 1848, in Lisbon, the Hospital de Rilhafoles was opened; in 1883 was inaugurated the Hospital de Alienados do Conde de Ferreira, in Oporto; and, in 1893, the Casa do Sagrado Coração de Jesus, in Sintra, received its first alienated. In all these spaces worked nurses, secular or religious. The aim of this research is to identify nurse’s responsibilities on the assistance of the alienated at Hospital de Rilhafoles, Hospital de Alienados do Conde de Ferreira and Casa do Sagrado Coração de Jesus, at the end of the nineteenth century. It was used a research and documental analysis, having Foucault as base, and were analyzed the following main sources: «Relatório sobre a Organização do Hospital de Alienados em Rilhafoles» (1851), «Regulamento Geral do Hospital de Alienados do Conde de Ferreira» (1883), «Regla de Nuestro Gran Padre San Agustín y Constituciones de la Orden Hospitalaria de Nuestro Glorioso Padre San Juan de Dios» (1890) and «Prontuario del Enfermero» (1891). The portuguese nurses were responsible for monitoring the alienated, ensuring that the hospital routines were followed, and that the self-care (e.g. hygiene, food) was guaranteed. They were also responsible for administering medication and the fulfillment of other treatments, such as hydrotherapy, occupational work or ergotherapy. By medical indication, nurses could also apply containment and restriction techniques (e.g. shackles, straightjackets), having to be gentle, affectionate and benevolent. Learning to be nurses in the spaces of the hospitals, they were also forced to live within them, making personal the institutional routines and merging their private lives into the public life of the institutions. Although the professionalization of portuguese nursing only occurred at the end of the 19th century, we know now that nurses were present in the care contexts that existed in the country until that time, and were also caregivers to the alienated who were in those realities. There is still a long path to make in the construction of the history of mental health and psychiatric nursing, on the scope of the portuguese conjuncture as well on an international level, and this work may provide a support for future research, that could involve not only nurses, but all those who intend to contribute for the development of nursing profession. Bibliography 1. 2. 3. 4. 5. 6. 7. Candeias, Analisa. Reprimir, Controlar e Disciplinar: o Quotidiano no Hospital de Alienados do Conde Ferreira (Século XIX). In Lobo de Araújo, Maria Marta & García, Alfredo Martín (Coord.). Os Marginais (295-304). Vila Nova de Famalicão: Húmus, 2018 Candeias, Analisa; Esteves, Alexandra & Sá, Luís. Cuidados de enfermagem em saúde mental e psiquiatria no início do século XX. Servir, 59 (2016): 47-54 Esteves, Alexandra. Loucos e/ou Criminosos: o Debate sobre a Inimputabilidade em Portugal entre Meados do Século XIX e Inícios do Século XX. In Lobo de Araújo, Maria Marta & García, Alfredo Martín (Coord.). Os Marginais (279-294). Vila Nova de Famalicão: Húmus, 2018 Orden Hospitalaria de San Juan de Dios. Regla de Nuestro Gran Padre San Agustín y Constituciones de la Orden Hospitalaria de Nuestro Glorioso Padre San Juan de Dios. Madrid: Imprensa del Asilo de Huérfanos del Sagrado Corazón de Jesús, 1899 (Traduzido do original de 1890) Rodrigo, José. Prontuario del Enfermero. Madrid: Imprenta y Librería de Nicolás Moya, 1891 Santa Casa da Misericórdia do Porto. Regulamento do Hospital de Alienados do Conde de Ferreira Elaborado por Antonio Maria de Senna. Porto: Imprensa Real, 1883 Sena, António Maria. Relatorio do Serviço Medico e Administrativo do Hospital do Conde de Ferreira Relativo ao Primeiro Biennio (1883-1885). Porto: Typographia Occidental, 1887 [22] The military influence in nursing as an international profession. Elsa Vitale1, Francesco Germini1, Fiorella Fabrizio2 ASL Bari, Italy; 2ASL Lecce, Italy 1 Background: Through her experience in the Crimean Wars, Florence Nightingale first brought attention to nursing as a career and profession and to needed changes in healthcare delivery (Sarnecky, 1999). Similarly, other wars have brought advances in how care is provided (Hesselman Kautz, 2014). The purpose of this review is to identify published research studies that have assessed military influence in nursing profession. Methods: This review of the literature uses studies published in English that were available in the PubMed database from 2000 to 2018. The population of interest consists of studies of registered nurses in the Army and Air Force. Studies were excluded if they did not meet the above eligibility criteria. The keywords used in the searches were: military influence, nursing profession, military nursing. A Boolean strategy using operators “AND” and “OR” was utilized to refine and ensure an exhaustive search was completed. Results: Two articles and one review of the literature were found that met the inclusion criteria for the review. Due to the variability in the studies and the luck of statistics reported in the majority of the studies, a meta-analysis examining the magnitude of relationship between military influence and nursing profession is not possible. However, the findings from these studies consistently identified models that demonstrated a relationship between various work related, organizational factors as an intervening variable between these military factors and the nursing profession. Discussion: This review has indicated that the military world influenced the nursing in its professionalization process (Heyes et al., 2006; Obrien-Pallas et al., 2006). As a result of this review, as well as advances made in design methodology and statistics, nurse researchers must expand the retention science with robust longitudinal intervention and evaluation studies (Zangaro, 2010). Future studies must be rigorous, inclusive of all services, and targeted to the current nursing profession. Bibliography 1. 2. 3. 4. 5. Nurse Corps. Philadelphia: University of Pennsylvania Press, 1999. Minerva 2000; 18(2):50-3. Hesselman Kautz B. The Army’s first Scvhool of Nursing and its influence on nursing education. Creative Nursing 2014. DOI: 10.1891/1078-4535.20.4.265 Hayes LJ, O’Brien-Pallas L, Duffield C, Shamian J, Buchan J, Hughes F, et al. Nurse turnover: A literature review. International Journal of Nursing Studies. 2006;43(2):237–263. O’Brien-Pallas L, Griffin P, Shamian J, Duffield C, Hughes F, Spence Laschinger HK, North N, Stone PW. The impact of nurse turover on patient, nurse, and system outcomes: a pilot study and focus for multicenter international study. Policy Polit Pract. 2006; 7(3): 169-79. Zangaro G, Kelley P.A. Job satisfaction and retention of miliotary nurses: a review of the literature. Annual review of nursing research 2010; 28:19-41. [24] The Contribution of Carolina Santi Bevilacqua to Nursing in Italy Elisa Ferrario1, Maura Lusignani2, Edoardo Manzoni3 Fondazione Don Gnocchi, Italy; 2Università degli Studi di Milano, Italy; 3Istituto Palazzolo di Bergamo, Italy 1 Abstract The Risorgimento is a social and political phenomenon which spread in Europe throughout XIX century and culminated in the burst of revolutionary movements. In that context, Italian political authorities decided to tackle newly emerged assistance issues, due to population growth and poverty, by entrusting aristocratic women to take care of the wounded soldiers. With this regard, in 1849 Giuseppe Mazzini solicited the presence of Cristina Trivulzo of Belgioioso. At that time, hospitals had poor sanitation, and their staff was untrained to tend to sick people and stem infections, main cause of death. Recent studies shed light on the previously unheard-of care activities that Italian women performed in those years and in so doing they retraced the origins of nursing. This historical investigation focused on the archive of countess Carolina Santi Bevilacqua, whom Lechi, prime minister of temporary Lombard government, appointed as supervisor of care assistance in Brescia, during the 1848 insurrections against Hapsburg dominion. With the help of other noble women, Leila Carini and Paolina Calegari, Carolina turned her palace into a hospital and reorganized the field hospital. She created a care assistance net, which made the transportation of patients into others hospitals possible, since the number of beds and staff were insufficient. Moreover, she required rooms to be clean, and provided each patient with a bed and clean linen. The staff was supported by “Ancelle della Carità”, hospital nouns lead by Paola di Rosa. As is witnessed by letters stored in this archive, these field operations – similar to those that Florence Nightingale also accomplished in those same years in Scutari – caused the decrease of infections and mortality. Afterwards Carolina collaborated in Rome with Belgioioso, and was awarded by King Carlo Alberto the gold medal. After Carolina's death, her daughter Felicita conducted her works which are still subject of study. Bibliography // [25] Gender, Race and Empire in Angela Bolton's The Maturing Sun Wendy Hazel Webster University of Huddersfield, United Kingdom This paper explores Angela Bolton's account of her experience of nursing in India, published in 1986 and titled The Maturing Sun. It focuses on gender, race, and empire and their intersections in Bolton's account of her wartime experience. Bolton was working in a country which was under British imperial rule and where there was very considerable opposition to British rule during the period she was nursing there. The paper considers the significance of this imperial context to Bolton's attitudes to the British in India as these are chronicled in The Maturing Sun and the significance of memories of empire in the decade when she was writing her memoir--the 1980s. The paper argues that Bolton's work as a nurse is central to her sense of identity in India. She is highly critical of the imperialist mentality that she observes in other Britons in India. But her own sense of identity is embedded in the community of British health workers in India and she exempts them and the British health care system in India from any criticism. Bibliography 1. 2. 3. Wendy Webster, Mixing It: Diversity in Britain in World War II (Oxford University Press, 2018). Wendy Webster, Englishness and Empire (Oxford University Press, 2007). Wendy Webster, 'Maintaining Racial Boundaries: Greater Britain in World War II', in Christian Pedersen and Stuart Ward (eds.), The Break-up of Greater Britain (Manchester University Press, forthcoming, 2020). [26] European Models of Overseas Public Health Nursing Introduced into Japan 1935-1943 Yuko Kawakami Kameda University of Health Sciences, Japan Objective The objective of this study is to show how overseas public health nursing influenced the early days of public health care in wartime Japan. It will look at expectations of the role of healthcare facilities developed through facility administrator experiences of public health nursing activities and Hokenkan, the predecessors to public health centres. In this study, the main European model introduced into Japan was from the U.K.; the U.S. was also influential. There is one main research limitation. Much of this research focuses on the journal “Public Health”, which was written in Japanese. It is difficult to understand the naming conventions, since professional names were already translated into Japanese, from other European languages. Methods This research used secondary literature from the “Public Health” journal, published from January 1935 to December 1943, when the journal ended publication. The number of copies published is unknown. Readers are assumed to be public health professionals and government officials across Japan. Background Before 1937, there was little public healthcare in Japan – financially disadvantaged people had little or no access to healthcare. In Japan, the development of the preventative concept was embodied in the slogan, “From treatment to prevention” in use from 1910 to the early 1930s. During this time, hygiene changed from being a police issue to being under the Ministry of Home Affairs. From 1926 to 1934, parallel problems were common in European countries including infant mortality, acute contagious diseases such as dysentery and typhoid fever as well as chronic diseases such as tuberculosis and venereal diseases. Support came from within Japan and Europe as well as the Rockefeller Foundation. By the 1920s, the Rockefeller Foundation was the largest grant-making foundation on earth and was the U.S. leading sponsor of medical science, medical education, and public health. Japan was no exception. With their support, one ‘urban health centre’ (toshi hokenkan), was founded in 1935 in Tokyo. Health centres were institutions dedicated to public health and were established across prefectures from 1937. According to Volume 52, Issue 2, 1934, health consultation had already been tried in Japan from 1922 in clinics and in elementary schools. Clinics and home visits were still considered to be on a trial basis. Then, “public health nursing” was defined in the journal as the “official organizations and public assistance given to anyone by a qualified nurse”. The four main goals were: education for health protection at the individual and family level, improved family and social conditions, public welfare, and development of education for public health. Dr. Sato wrote in the “Public Health” journal (vol. 52, No.2, 1934), that public health nursing (koushueisei-kango) was a relatively recent facility for public health, providing nursing for diseases and health education about public hygiene. He comments that the system of public health nursing was founded in the U.K. and subsequently spread around the world. He states that the school nurse occupied a primary role in public health nursing in the U.K. As public health improved, the variety of nomenclature also increased and were more firmly determined to show the different activities of the nurse practices. There were eight classifications for nursing activities: visiting, child welfare, maternity, schools, tuberculosis, industrial, as well as mental hygiene services, and hospital social services. Results Thirteen countries had professional nursing organizations: U.K., Belgium, France, Germany, Czechoslovakia, Yugoslavia, the Netherlands, Hungary, Romania, Poland, Bulgaria, Austria, and the U.S. In all of these countries, clinical nurses could also go to public health nurse training institutions. There were various training institutions depending on the country, public, university, associated hospital, and through the Red Cross. The “Public Health” journal provided an overview of the status of public health centres and medical treatment in various counties (Vol. 55, No. 5, 1937). Before World War I, the word “health centre” was used for the first time in the U.K., indicating a “Maternity and Child Welfare Centre”. There was one public health centre per 100 births in the U.K. They offered extremely minor assistance for medical treatment. The article states that in Romania, primary health care centres served a population of 10,000 and secondary health care centres served 50,000; an explanation on the differences between primary and secondary health care centres in Romania is not provided. It stated that Poland had a total of 210 health care centres. Depending on the population of their locations, each health centre served between 31,250-41,667. Information on the number of health centres in France is not reported - instead, it is stated that medical treatment took place at venereal disease centres. Similarly, in Yugoslavia, some public health centres performed medical treatment as substitutes for hospitals. Data on the U.S. reports only on the number of health centres - growing from 72 in 1919 to over 1,000 in 1926. The populations they served was not specified. This information can be compared with the growth of public health care centres in Japan. The Japanese health centre law of 1937 established 49 health centres - one in each of Japan’s 46 prefectures, plus one in Kyoto and two in Osaka - each served an average population of about 130,000. The titles from the Japanese Journal of Public Health used for nurses in different countries depended on their workplace location and activity. The Japanese word kangofu (nurse) is commonly used in conjunction with another noun such as koushueisei. For example, the [27] koushueisei-kangofu (public health nurse) in Austria worked in maternal child protection, school hygiene, tuberculosis prevention and hygiene education. The same term was used to refer to nurses in Poland who worked with local residents. Another example is houmonkangofu (visiting nurse) used in Bulgaria for nurses who worked with local residents. By contrast, the term used in Germany hokenhoushiin could be literally translated as person in the service of health. Even though the nurses in Poland, Bulgaria, Austria and Germany all worked primarily at public health centres, the Japanese language translation showed significant diversity. Reference to the U.K. described “visiting women” and “school nurses”. In addition, “home visiting health care workers” were also used in multiple countries, for example, France, Bulgaria, some states in the U.S., and China. Several articles also mention entry qualifications to nursing training institutions, the term and period of education, as well as salaries and transportation, provision of uniforms and language skills. “Public health nurse”, “visiting nurse” and “traveling nurse” were often used. Some articles indicated that the Japanese translator chose the titles for nurses staffing the health centres in different countries. The public health nurse regulation (1941) triggered the new occupation of public health nurse in Japan. They called the public health nurse “hokenfu”. Recognizing the importance and completion of the move from therapeutic to preventive medicine, in 1937 Japan’s public health centres started with financial assistance from the Rockefeller Foundation. At that time, the Governor of the Ministry of Health and Welfare stated that in the future, facilities will be required for disease prevention and improvement of physical standards for Japanese. Finally, the journal included photograph from the healthcare activities and establishments overseas. For example, a photograph from Nazi Germany showing public health nurses bathing children appeared in a 1935 journal. Also in 1941, a photograph was included of a child health centre in Tergnier, France. In 1938, the journal publicized the U.K. Minister of Health laying the cornerstone to mark the start of construction for a dormitory for nurses treating tuberculosis. Discussion In the “Public Health” journal, overseas public health was introduced in detail, focusing on the U.K., the U.S., and European countries. Although there were country-to-country differences regarding the development process and methods of public health, they revealed that all were closely linked to the prevention of tuberculosis. Also, from the requirements of nursing education and treatment, the nursing profession came to be seen as an indispensable entity forming the basis of health centres. In Japan, war became the driving force for healthcare. The situation may have been similar in some European countries. During this time, it is interesting to note that while Japan was at war with other countries, there were nevertheless positive dynamics between European and Japanese healthcare systems. What message did the “Public Health” journal want to send to readers? While emphasizing Japan’s particular development, authors felt the need to catch up with similar developments in Europe and the U.S. Bibliography 1. Formation and Evolution of the Public Health Nursing in Prewar and Wartime Japan (Kazamashobo: Tokyo, 2013, in Japanese), ISBN978-4759919783. [28] Shell shock and Talking Cure. A new nursing challenge during the First World War. Valentina Chiccoli1, Maria Luisa Pancheri2, Anna La Torre3 Research Nurse, ASST Papa Giovanni XXIII, Bergamo; 2Nursing Science University Coordinator, IRCCS National Cancer Institute, Milan); 3RN, Self-Employed, MscN, MA in History 1 The disruptive world war one generated thousands of casualties, but between the common wounded and sick soldiers a new syndrome spread: shell shock. It was related to apparently physically healthy men but psychologically ill, and this was because of war horrors causing them an emotional trauma. This syndrome soon became a new nursing challenge, as soldiers were living in trenches between rules to follow, unending explosions and terrible visions of comrades’ deaths: all of this caused to these men many symptoms, both physical and psychological. Soldiers manifested mutism, deafness, shivering, stuck eyes, nervous tics and nightmares. Nurses looked after these men in different ways and environments depending on the fact that the disease was acute or chronic. The first place nurses looked after them was the front, where they had to guarantee basic needs for restoring physical strength and for allowing these men to come back to the fighting lands again. Here nurses were involved in food preparation and giving rest and relief from trench lives. When it was not enough these men were moved in the backward in the so-called CCS, mobile stations for soldiers declared definitely unable for fighting. Here nurses assured a physical recovery but also decided if soldiers needed recovery in hospitals. Dedicated wards were created and here chronic patients were moved. These men were involved in different kind of activities that could help them to maintain their individuality and ability to be independent and to reduce symptoms like shivering and nervous tics by using small tools and doing activities in woods or workshops. Nurses were there to assist these men but the new challenge was soon clear, as the focus was not just on the physical recover. In fact, these men lived a deep existential crisis, made of nightmares, loss of control over their bodies, mute and isolated because of fright of other people, with fragmented identities generated by the war. Nurses were not a passive presence next to these men. They were the ones looking after them time after time, always trying to get in touch for rebuilding a personality on a broken human being by listening and witnessing without judging. This became the real nurse challenge, the ability of staying next to not just physically but supporting these men with words, actions or silence when it was necessary. The talking cure was introduced in war hospitals for helping these soldiers to recount war horrors with writings or paintings. Nurses helped these men to tell their stories as it was therapeutical and it helped them to get the terrible experiences lived away. It allowed the world to know about the reality that they could not tell. For nurses it was a big deal, as the recovery of these men was not just physical. It was and activity of containment of trauma, as nurses created a therapeutical environment for getting the body restored and the soul recomposed. Bibliography 1. 2. 3. 4. 5. 6. 7. 8. 9. Warner A. Nurse at the Trenches: Letters Home from a WWI Nurse. POD: Diggory Press; 2005. Jones E, Wessely S. Shell Shock to PTSD: Military Psychiatry from 1900 to the Gulf War. New York: Psychology Press; 2005. Gibelli A. L’officina della guerra. La Grande Guerra e le trasformazioni del mondo mentale. Torino: Bollati Boringhieri; 2014. Reid F. Medicine in First World War Europe: Soldiers, Medics, Pacifists. New Delhi: Bloomsbury Publishing; 2017. Grogan S. Shell Shocked Britain: The First World War's Legacy for Britain's Mental Health. Barnsley: Pen and Sword; 2014. Durst Johnson C, Meredith JH. Understanding the Literature of World War I: A Student Casebook to Issues, Sources, and Historical Documents. Santa Barbara: Greenwood Publishing Group; 2004. Owen W. The Hydra: Journal of the Craiglockhart War Hospital. Oxford: Oxford University Press; 1998. Borsay A, Dale P. Mental health nursing: The working lives of paid carers, 1800s-1900s. Oxford: Oxford University Press; 2015. Hallet EC. Containing Trauma: Nursing Work in the First World War. Manchester: Manchester University Press; 2011. [29] The development of British Army nursing through the eyes of three women (Part 1: Miss Veysie) Keiron Spires, Fiona Mitford Queen Alexandra's Royal Army Nursing Corps Association, United Kingdom This is the first of three linked papers that will show how the development of Army nursing can be seen through the eyes of three ordinary Army nurses, and also show how Florence Nightingale influenced the development of British Army nursing. Penelope Gertrude Veysie was born on the 18th August 1807 at Plymtree, in Devon, the daughter of Reverend Daniel Veysie, Rector of Plymtree, and Mrs Anne Veysie. Her older brother, William Veysie went on to reach the rank of Lieutenant Colonel in the 7th Bengal Cavalry, in India. She trained as a nurse at St John’s House in London. St John’s House was founded in 1848 as a 'Training Institution for Nurses for Hospitals, Families and the Poor'. It was a religious community run by a Master, who was a clergyman, and a Lady Superintendent. The aim was to improve the qualifications of nurses, and also to raise the character of nurses by providing moral and religious instruction. The Institution opened at 36 Fitzroy Square, in St Pancras, and was named St John's House because it was in the parish of St John the Evangelist. It provided training for both the ordinary working-class nurses, who today we would call Staff Nurses, and for upper-class ladies who were to be the unpaid Sisters and Lady Superintendents. As they were a religious sisterhood the trainee nurses were called probationers. Although this was an Anglican Sisterhood the nurses did not take vows of celibacy, religious obedience or seclusion. The Church wanted the nurses to have a free and willing devotion to the care of the sick as part of Christian charity. St John’s House had a centralised nursing department with the staff nurses reporting to the Sisters, and the Sisters to the Lady Superintendent, a model which was to eventually become the norm throughout the Englishspeaking world. The probationers received board, lodging, medical assistance, laundry, and clothing, and were paid one pound a month for their services. They nursed in hospitals and private houses, and when required attended the sick poor. If at the end of five years they had proved themselves worthy, they received a certificate and were entered on the St John’s House list of certified nurses. The Sisters paid for their training and if resident, also for their board and lodging. In 1854 six nurses from the St John’s House went out to the Crimea with Florence Nightingale, since St John's House was at that time one of the few sources for trained nurses. In 1856 the Sisterhood took over the nursing of King's College Hospital and from 1862 to 1868 a six-month training in midwifery nursing was given there, with the help of a grant from the newly founded Nightingale Fund Council. When people think of nursing in the Crimea they usually think of Nightingale at Scutari, however there were many other nurses, many of whom were not under the jurisdiction of Nightingale, and many other hospitals. In November 1854, following Florence Nightingale's success at Scutari the Admiralty decided to send out "tried and approved nurses" selected by a Ladies Committee in London, and establish a 40 bed hospital at Therapia. Many of the patients were to be marines and men of the Naval Brigade from the Siege of Sevastopol. In January 1855 the Reverend & Mrs McKenzie arrived with a small party of ladies and nurses. Mrs McKenzie, an experienced nurse, having trained at the Middlesex Hospital had as one of her three assistants Miss Gertrude Veysie. A number of the nursing staff proved inadequate or incapable and soon left or were dismissed. Later many tributes were paid to the quality of the management of the small hospital and the ensuing parliamentary report stated: "They shrank from no kind of employment however dangerous or laborious nor was there any office connected with the sick which they deemed to be low or demeaning ... Miss Veysie remained behind until the termination of the war happily brought her labours to a close ... their services will live long in the grateful remembrance of the officers, seamen and marines who fought before Sevastopol”. This is an extract from a letter sent home from Therapia by George Waller to his father: “I have come down here for change of air & it is a delightful place. From about 200 yards to the left of the Hotel you can see the opening of the Bosphorus where the Black Sea runs into it consequently we get the sea breeze every day as regular as possible. I am afraid I shall have to go back to Scutari tomorrow but I shall try to be allowed to come here again as this place is so infinitely superior to the other. We bathe almost out of the Hall door of the Hotel every morning.” Gertrude Veysie’s work in the Crimea was acknowledged by the Sultan of Turkey who gave her a gold and diamond brooch which is part of the Heritage Collection owned by the Queen Alexandra’s Royal Army Nursing Corps Association. Nightingale and also Mary Stanley had similar brooches awarded, but it is not clear who else might have received one. In all 29 were made by Hunt and Roskell, a renowned jewellers and silversmiths on Bond Street in London. Miss Veysie also had a very poignant letter sent to her by a group of English Sailors in the form of a flag puzzle.The puzzle is in the form of the union jack. The flag is made up of different components and the sailors explain what they all mean and how to create them with the puzzle pieces. This is also in the QARANC Association Heritage Collection. It cannot be claimed that the nursing reform movement at this time was solely due to the influence and example of Florence Nightingale, nor can it be assumed that the training she started at St. Thomas's Hospital was the first training provided for nurses in Britain. There were earlier English nursing reformers like Elizabeth Fry, the Quaker philanthropist who founded the Training Institution for Nursing Sisters in 1840, and several Anglican sisterhoods, all of which had been established by 1848. One of these was the Sisterhood of St John's House. Monica Baly, in her work on Nightingale, also indicated that in the earlier part of the century the standard of nursing had been improving. She, too, acknowledges the contribution of the Anglican sisterhoods, specifically mentioning St John's House. The St John's House nursing system was a primary model for Nightingale when she set up her school at St Thomas's, and the Lady Superintendent of St John's House, Mary Jones, was to become one of Nightingale's dearest friends. Gertrude Veysie and the other St [30] John’s House nurses who had worked in the Crimea returned and brought back their experiences, skills and knowledge to add to the discussions and discourse taking place. During the Crimean campaign the nurses moved from location to location either to visit, or to work, or to be cared for when they themselves were sick. Gertrude Veysie and Mary Erskine nursed Florence Nightingale at Therapia when she became sick with a fever which is thought to have been caused by brucellosis. There is ample evidence of correspondence between the nurses working in different locations, including Nightingale to Mary Erskine at Therapia. Nightingale herself acknowledges that she gained many ideas about nursing by seeing the ways in which nurses in the other hospitals worked and were managed. A large number of nurses went to the Crimea and brought back ideas and experiences. Many were not in a position to influence nursing reforms either in nursing generally or nursing in support of the military. Many of the more educated and well-placed ladies were able to be part of the discourse that followed the Crimea and each used different avenues or different people they knew to get their views across. The sharing of ideas and experiences both during the war in the Crimea and afterwards when the nurses returned was an important factor in shaping the ideas of Nightingale and others taking forward nursing reforms. It was also an important factor in the shaping of nursing support to the British Army. Bibliography // [31] The development of British Army nursing through the eyes of three women (Part 2: Florence Nightingale Shore) Keiron Spires, Olivia Barnes Queen Alexandra's Royal Army Nursing Corps Association, United Kingdom This is the second of three linked papers that will show how the development of Army nursing can be seen through the eyes of three ordinary Army nurses, and also show how Florence Nightingale influenced the development of British Army nursing. The second Army Nurse in the exploration of Army Nursing and Nightingale’s influence is Florence Nightingale Shore who served in both the Boer War and the First World War. Miss Shore’s father was a cousin of Florence Nightingale and Florence Nightingale was Miss Shore’s Godmother. Miss Shore was born on 10th January 1865 in Stamford, Lincolnshire and grew up in Derbyshire. She was educated at the High School York and in. Brussels. In 1891 she travelled to China to work as a nursery nurse, returning to the England in 1893. This must have been a real undertaking for a young lady and shows her adventurous spirit. At the age of 28 she started her nurse training at The Royal Infirmary in Edinburgh, Scotland, completing her training in 1896. She also completed training in midwifery and in district nursing. Miss Shore would have trained in the style now known as the “Nightingale” system. This was a three year structured programme with theoretical and practical elements. In the Army most nursing care at this time was being undertaken by orderlies. We might imagine that orderlies were unskilled and lacked the compassion of the female nurses. It is evident from archival records that the training syllabus of the orderlies closely matched that of nurses, and many developed high levels of knowledge and expertise. Under the Cardwell reforms, soldiers spent less time in the Regular full-time Army and longer in the Reserves. This did mean that many of the most capable orderlies left the service. Many nurses found serving in the Army Nursing Service very difficult and the turnover was very high. It was not until the Boer War in 1899 that things began to change. The Boer War had started in 1899 and was the first conflict that saw British Army Nurses deployed in significant numbers. It was also a pivotal point in the development of Army nursing laying the foundations of what was to become the format for Army nursing in future conflicts. On 18th May 1900 Miss Shore joined the Princess Christian’s Army Nursing Service Reserve. The Princess Christian nurses were given a small silver medal, which is known as a tippet medal, to wear. This started a tradition of Army nurses wearing tippet medals. The Queen Alexandra’s Royal Army Nursing Corps Association has many examples of these in its Heritage Collection. The Princess Christian Nurses were part of the 2000 strong nursing contingent from many parts of the world serving in South Africa between 1899 and 1902. Most of the nurses would have benefited from the Nightingale style of training, all the British nurse had trained for at least three years, and had been vetted very carefully by a committee chaired by Princess Christian. Miss Shore was deployed to the Imperial Yeomanry Hospital at Deelfontein from April 1900 to September 1900. Some of the nurses going to South Africa were relatively young and inexperienced but Miss Shore, then aged 35, had 7 years nursing and midwifery experience. The Imperial Yeomanry Hospital was unusual in that it was paid for by public fund raising and staffed by a mixture of military and civilian doctors. The hospital had 40 Army nurses allocated to it. By the middle of June 1900 provision had been made for the accommodation of nearly 800 patients. The hospital was subsequently enlarged to take 1000 patients. The Army nurses now took over much of the bedside care as envisaged by Florence Nightingale. Army nursing had now developed as an entity, however, there is little written material to help us visualise what duties Miss Shore herself would have undertaken. We do know from the accounts of other nurses, that they were involved in triaging the sick and wounded; in helping patients with hygiene needs; in helping ensure patients had adequate nutrition and the correct diets; they worked in the operating theatres and did much of the dressing of wounds. They supervised the orderlies and cared for the seriously sick patients themselves. We also know they wrote letters for the patients and tried to find such comforts for them as were available. Enteric fevers were commonplace and sadly nurses also died of disease in this campaign. The Army Nursing Service created a structure which allowed for flexibility as to how nurses were deployed, and many moved from hospital to hospital. From the medal rolls we think that Miss Shore stayed in Deelfontein for all of her time in South Africa. The medal rolls show us that nurses who served in South Africa were entitled to the same campaign medals as the soldiers. The Queen’s South Africa Medal and the Kings South Africa Medal for those serving towards the end of the war. We have some examples of these with us today. The mix of doctors and nurses with military experience and those with experience of working in civilian hospitals led to a blending of skills and expertise and in the subsequent reviews of medical support during the Boer War these ideas were put forward and many changes were made to Army nursing. Shortly after the end of the Boer War, in 1902, the Queens Alexandra’s Imperial Military Nursing Service was formed. In 1908 the Queen Alexandra’s Imperial Military Nursing Service (Reserve) was formed, and Miss Shore transferred into the new reserve service. Bibliography // [32] The development of British Army nursing through the eyes of three women (Part 3: Mary Chavasse) Alison Spires, Rebekah SloaneMather Queen Alexandra's Royal Army Nursing Corps Association, United Kingdom This is the third of three linked papers that will show how the development of Army nursing can be seen through the eyes of three ordinary Army nurses, and also show how Florence Nightingale influenced the development of British Army nursing. Mary Chavasse, known as May, had six bothers and sisters. Of the seven children five served overseas during the First World War. The involvement of whole families was not uncommon. Christopher Chavasse studied at Trinity College, Oxford, with his identical twin, Noel. He was very athletic, and represented England at the 1908 Olympic Games. After Oxford, he went back to Liverpool to study for Holy Orders. He was ordained in 1909. On the outbreak of war he immediately volunteered as an Army Chaplain. By the end of the month he was involved in the retreat from Mons. He was wounded at Cambrai in 1917, and awarded the Military Cross and Croix-de-Guerre. He entered Germany with the 9th Corps in 1918 and left the Army in 1919 with the rank of Second Class Chaplain. Noel Chavasse was Christopher’s twin brother, and also studied at Trinity College, Oxford. He also competed in the Olympic games of 1908. He studied medicine at the University of Liverpool and Royal Southern Hospital under Sir Robert Jones. After the outbreak of the war, he went to France as an Army doctor attached to the Liverpool Scottish Regiment. There he won the Military Cross at Hooge in May 1915, and the Victoria Cross at Guillemont in August 1916. He was famous for his dedication to the wellbeing of his men and his bravery when rescuing wounded soldiers from no-man's land. He was seriously wounded by a shell on 2 August 1917 while attending to wounded men in no-man's land. He subsequently died on the 4 August and was buried at Brandhoek military cemetery. He was posthumously awarded a second Victoria Cross. He was the only man to receive two Victoria Crosses in the First World War. Francis Bernard Chavasse, studied Natural Sciences at Balliol College, Oxford. At the time of the outbreak of the war, he was near completion of the medical course at Liverpool University. Upon qualification as a doctor, he was sent first to Egypt, then to France with the 17th Battalion of the King’s Liverpool Regiment. He was wounded and awarded the Military Cross. Aidan Chavasse was due to go on to Wycliffe Hall to read Theology, but his plans were interrupted by the outbreak of the war. He went out to France with the 11th Battalion of the King’s Liverpool Regiment. He later transferred to the 17th Battalion of the King’s Liverpool Regiment, to which his brother Bernard was Medical Officer. During a mission to inspect German wire near Sanctuary Wood in July 1917 he was wounded in the thigh. He sent his patrol back to safety and took cover in a shell hole. Subsequent attempts to find him, including three separate attempts by his brother Bernard, were unsuccessful and Aidan was never found. Mary Laeta Chavasse known as May, was born in 1886 at Oxford. She was one of twin sisters. Early in the war both May and her twin sister Marjorie volunteered at a convalescent hospital for soldiers at Rednal, Worcestershire, run by their Aunt Frances. May enrolled as a VAD and travelled out to France in March 1915 to work as a ward maid at the Liverpool Mobile Hospital. Following the outbreak of the First World War the British Red Cross formed the Joint War Committee with the Order of St John. They worked together to pool their fundraising activities and resources. They organised Voluntary Aid Detachments (VADs) at home and abroad, which were of vital importance in providing aid to naval and military forces during the war. Members of the Voluntary Aid Detachments or VADs became known as VADs themselves. When people discuss VADs they often think of those who worked in support of trained nurses, either in Red Cross Hospitals or in Military Hospitals at home and overseas. However, VADs carried out a wide range of tasks as you can see in this advert calling for “nursing members, cooks, kitchen maids, clerks, house maids, ward maids, laundresses, motor drivers etc.”. Sometimes we also forget that many VADs were men. The number of VADs serving in military hospitals in France was small in comparison to the number of Army nurses. Nonetheless they made a significant contribution. Army nurses mention the work of the VADs in their diaries and reports. They were seen as an important part of the workforce who together as a team cared for the sick and wounded, and created the best environment they could for both patients and staff. In addition to supplying VADs to the Military Hospitals, the Red Cross also supplied 10 complete hospitals staffed by Red Cross members. Many of these were funded by public donations or had wealthy sponsors. May Chavasse volunteered as a Ward Maid in one of these, No. 6 British Red Cross Hospital, more commonly known as the Liverpool Merchants Hospital. With medical services becoming essential in France, Lord Derby appealed to the merchants of Liverpool to provide funding for facilities. Within 24 hours, enough was raised to build the Liverpool Merchants Mobile Hospital. This was a timber, collapsible structure that was shipped to Etaples and set up in a large complex of hospitals. It was fully equipped and had space for 200 beds, rising to 250 in an emergency. The hospital remained in Etaples until June 1918, when there was a series of air raids and a number of bombs fell onto the hospital and those nearby. The hospital was moved to Trouville where it remained until 1919, having tended to over 18,000 patients. May served with the hospital from the 1st April 1915 to the 11th December 1918. She was Mentioned in Sir Douglas Haig's Despatch of 9th April 1917. Between 1922 and 1925 May Chavasse trained as a nurse at the Nightingale School of Nursing at St Thomas’ Hospital, London, which provides a link to our very first paper. At the outbreak of The Second World War May Chavasse joined the Queen Alexandra’s Imperial Military Nursing Service (Reserve) and was mobilised for overseas service. In the period between the two World Wars many nurses with military experience married and had families, whilst others became too old for service in the Second World War. So some of the experience and knowledge of military nursing was lost. Nonetheless, as in [33] previous conflicts, there was a core of regular Army nurses and also a framework in place for the rapid expansion of the nursing service, firstly by mobilising existing reserves, and then by recruiting new members into the reserves. May Chavasse was one of those who had military experience even though it was now 20 years since she had served in France. There are records in the archives of others who served in both World Wars. The Second World War was very different from the First World War. It was a more mobile war and weapons had become far more destructive. Hospitals and other medical resources had to be prepared to move with the ebb and flow of battle. The higher risk to medical assets and staff meant that nurses wore battledress rather than the nurse’s uniforms we saw in previous conflicts. Like nurses in conflicts throughout history, they had new skills to learn. For example, the management of wounds changed significantly with the advent of antibiotics, and there were huge advances in plastic and reconstructive surgery requiring specialist nursing skills. What was it that nurses found attractive about Army life? Alison and Keiron Spires from the QARANC Association had the privilege to interview a veteran nurse, Vera, who had served in the Second World War. She was 102. She was asked about her life as a QA and she said: “I liked the … I liked the atmosphere … everybody got on together … it was like one huge family … everybody helped each other … oh it was a nice atmosphere … really was good” When asked about her strongest memory she said: “The best time … when we embarked for … we didn’t know where we were going … this train journey from Hatfield to Liverpool … we had no idea where we would be going and what was in front of us … the unknown …” Anyone who has served as an Army nurse will recognise these sentiments, and much of what makes an Army nurse has not changed since before the Crimea. They wear different uniforms, have new skills and are better educated. There are men as Army nurses. Yet still the words of Vera resonate with Army nurses and provide a link with their history. May Chavasse went back to civilian nursing after the war and she and her sister Marjorie both lived to be over 100 years old themselves. Bibliography // [34] Spanish Military Nursing In The War Of Africa (1859-1860) Juan Manuel García-Cubillana, Francisco Glicerio Conde Mora, José María Montero University of Cádiz, Spain This article refers to Spanish military personnel and health equipment during the African War (1859-1860), the pharmacopoeia used, the health tactic used, the treatment of the wounded, the cholera outbreak and the state of the hospitals. In the previous decade there had been a number of milestones in medicine, such as the discovery of anesthetics by inhalation—ethyl ether (Horace Wells and Willian Morton, 1844) and chloroform (James Young Simpson, 1847)— the principles of asepsis and antisepsis (Ignác Semmelweis, 1847) and the onset of hypodermic needles (Wood and Pravaz, 1853). These innovations were gradually implemented by Spanish Military Health and some of them applied by doctors and practitioners during the African War (1859-1860). Bibliography 1. 2. 3. 4. 5. Jurgen Thorwald. El siglo de los cirujanos. Barcelona: Ediciones Destino, 1958. L. Gómez Rodríguez. La Sanidad Militar en la Guerra de África (1859-1960). Sanidad Militar 2013; 69 (2): 127-133. Antonio Población y Fernández. Historia Médica de la Guerra de África. Madrid_ Imprenta de Manuel Álvarez, 1960. Sánchez Regaña J. La atención médica durante el desastre de Annual, 2013. J. Martín Sierra. El papel de la Sanidad Militar en la campaña de Marruecos (1859-1860). Sanidad Militar 2014; 70 (3): 157173. [35] The legend of Salome, the doubting midwife Jane Salvage Independent nursing consultant, United Kingdom Two midwives were at the heart of the nativity story of Jesus Christ, according to an early Christian gospel. In the second-century Legend of the Doubting Midwife, Salome attempts to examine Jesus' mother Mary to test her virginity. Her hand is withered as punishment, and then healed by the baby. The apocryphal miracle and its aftermath was retold in numerous paintings, sculptures, sermons, mosaics, mystery plays and poems. For centuries the midwives were loved and celebrated throughout Christendom, for their care after Jesus was born - and for his first miracle. They were represented for more than a millennium. In painting after painting, for example, they bathe holy babies, wrap them in swaddling clothes and chuck them on the chin. With other members of female birthing communities, midwives also appear in many representations of saints' nativities, including Mary herself and John the Baptist. These images came from the traditions of the Early Christian, Protestant, Roman Catholic and Orthodox faiths, across many centuries and countries. Many were created by renowned artists, from Giotto to Goya, Murillo to the Moscow School of ikon painters. A few were painted by women, including Lavinia Fontana and Orsola Maddalena Caccia, and many more probably bear the marks of uncredited female hands. The earliest visual telling of the story I have found is a fine example carved on an ivory throne around 550. It shows the life of Christ, including his nativity framed by intricate grapevines, birds and beasts. The star shines down on the ox and ass, Joseph and the tightly swaddled baby like a little mummy in his wooden manger. Below, Mary reclines and Salome bends over her. Both are looking at the midwife’s drooping hand, just after she has tried and failed to do her examination. Mary looks shocked and a little disapproving. This throne, a gift to Archbishop Maximianus of Ravenna, was made in the Byzantine empire - the only example I've found of the episode in Byzantine art, where midwives often appear but only in dutiful mode. Despite their earlier fame, I knew nothing of them before I attended a course about nativity art at the British Institute of Florence. According to its librarian and art historian Mark Roberts, Salome and her fellow midwife Zebel were a familiar part of the iconography. They, the life-savers, were considered even more important than the shepherds, the messengers. While Salome and Zebel attend Jesus' nativity, there are also many other unnamed midwives, wet-nurses and other birth attendants, who in intriguing, often beautiful and heart-warming images speak of women's tender care of mothers and newborns. Their many representations, looked at by women, show women down the ages looking after other women. They also have a dark side – Salome's miracle was used as anti-Judaic propaganda symbolising the supplanting of the old Jewish religion by the new Christian order. By the early 15th century she was increasingly depicted as an old crone, witch-like with a hook nose. They still appear in ikons of Eastern churches, but in western Europe they gradually vanished from nativity art and literature. Their representations and their virtual disappearance in the early 18th century speak eloquently but also cryptically of midwifery practice and its medical, social and religious significance. They pose interesting questions about their wider significance, historical midwifery practice and declining status. Having spent much of my life fighting for the recognition of women as carers, healers and leaders, I wanted to know more, and to bring them back to life. Here was an appealing story, now rarely told; I have rarely met a nurse or midwife who knows it. Yet, as I found when I began my research, the nativity midwives' roles and meaning were mostly ignored by pre-feminist art historians. Traditionally, these mostly male historians describe in detail every other figure and object in a nativity painting and expound their meaning, yet pass over most of the female figures. If they are mentioned at all, they are called servants, maids, or bystanders. Today they occasionally appear in feminist studies and novels, but are still largely unknown, mostly hidden from history. This work in progress is a creative non-fiction study that adopts a cross-genre approach to tell these midwives' stories, explore their meanings, and consider their fate in the light of historical changes in women’s lives and midwives’ status. Framed and informed by my career as a global nursing leader, writer and policy activist, it is a unique synthesis of women’s history, art history, social history, the history of medicine, travel and memoir. I aim to bring the Doubting Midwife and her many sisters back centre stage. Their story and the issues it raises remains relevant to women's work, the control of childbirth and public image. I want to rehabilitate them, and to situate them in the current subordination and shortage of women health workers. Keywords Midwifery / Art history / Women / Christmas References Salvage J (2011). Celebrate midwifery at Christmas. NMC Review, Issue 4. Nursing and Midwifery Council, London, UK. Salvage J, Stilwell B (2018). Breaking the silence: a new story of nursing. Journal of Clinical Nursing. Vol 27, issue 7-8, pp 1295-1721, e1242-e1685, April. https://onlinelibrary.wiley.com/doi/epdf/10.1111/jocn.14306 Bibliography 1. Salvage J, White J (2019). Nursing leadership and health policy: everybody's business. International Nursing Review, 23 May, https://doi/full/10.1111/inr.12523 [37] Jewish Nursing Eva Maria Ulmer, Birgit Seemann, Edgar Boenisch Frankfurt University of Applied sciences, Germany The following findings are based on the foundational work of Hilde Steppe (1947-1999), a pioneer of research into nursing history. She was the first to document the history of Jewish nursing in Germany, particularly in Frankfurt am Main, in her dissertation in 1997. Following her early death, we have continued and expanded the work on this topic within the Research Project "Jewish Nursing History" since 2006. The emergence of Jewish nursing care must be viewed in the context of a professionalization of nursing in the 19th century. Alongside Christian and secular nursing care - such as Catholic orders, Protestant associations and secular associations - a branch of nursing care emerged that was based on the ethical and religious values of Judaism. These include both 'Zedeka', meaning charity, in its various aspects, and the commandment to visit the sick (Bikur Cholim). However, both principles were voluntary and not professionalized, and so did not involve payment or any standardized training with specialized knowledge. Three major developments finally contributed to the foundation of the Association for Jewish Nurses in Frankfurt: 1. the incorporation of Jewish communities in the German-Israelite Union (DIGB) 2. the union of independent orders or ‚lodges’ (Bne Briss U.O.B.B) and 3. the establishment of independent associations, often initiated by Jewish women, in various locations across Germany. The German-Israelite Union was constituted in 1872 as the umbrella organization of Jewish communities in Germany. Its aim was to aggregate the various concerns of the individual communities with regard to social work, charity as well as the fight against antisemitism. To that end, it also took charge of the education of Jewish nurses. An application submitted to the German-Israelite Union in 1882 to endorse the education and training of Jewish nurses following the example of the Christian "motherhouse" lists three reasons: 1. to ensure care for the sick through Jewish personnel, 2. to provide for single Jewish women, otherwise not provided for, and 3. to prove that Jewish women were equally suited for nursing care. The applicant argues as follows: "To meet the generally great needs, it was necessary that »an association for the establishment of a convent house Demand is seen mostly in rural areas. Nursing care should rather continue to be a voluntary service, since the profession would prevent Jewish women from marrying. In spite of these objections, the idea of formal training for Jewish nurses is carried further and included in the program of the German-Israelite Union in 1882. The second organization to support the professionalization of Jewish nursing care was the independent order Bne Briss U.O.B.B., which was established in 1882 as the first German offshoot of the organization of "lodges" headquartered in the US. They pursued both cultural and charitable causes. In 1881 - almost in parallel to the discussions going on within the German-Israelite Union - an initial survey was conducted to assess the need for professional Jewish nursing care. Here, too, opinions were divided and an overall negative sentiment predominated. Nevertheless, the idea was carried forward by a few members ('brothers') from Frankfurt. In 1889, a committee for the education of Jewish nurses was formed. Now for the third group. At several locations across Germany, nursing associations were established, in order to promote and regulate the education and employment of Jewish nurses. Frankfurt was a forerunner here. The foundation of the Association for Jewish Nurses of Frankfurt am Main combines two of the aforementioned developments. By 1893, a total of five women had been trained in the hospital of the Israelite Community. Together, they established the Society of Jewish Nurses in 1893. At the same time, the lodge was taking action and some doctors lent their support, so that on October 23rd 1893, the Association for Jewish Nurses of Frankfurt am Main was founded. Students were trained at the hospital of the Israelite Communit, training usually lasted one year with a three-month trial period. They commited themselves to serving at least three years as a nurse in the association, after completing their training. So, after all, an organizational structure had emerged that was similar to the 'motherhouse'; nurses and students were lodged right next door to the hospital and assigned to their respective nursing positions by the Association. They did not earn a salary but were provided with a stipend as part of their membership in the Association, as well as cover for sickness and old age. Allow me to introduce one of the founders of the Jewish nursing association of Frankfurt: Klara Gordon (1866-1937), an "upstanding Jew, universally respected as an excellent representative of her profession". Born in Eastern Prussia, she arrived in Frankfurt in 1890, in order to train as a nurse in a Jewish environment. As already mentioned, she and four of her colleagues founded the Society of Jewish Nurses, which then merged with the the Association for Jewish Nurses of Frankfurt am Main that had been established by male doctors and sponsors. She completed her one-year training in 1893 and began working in inpatient and outpatient care. In 1897, the Association of the Jewish Hospital in Hamburg, which at that time did not have a nurse training program of its own, enquired in Frankfurt after an experienced nurse, suited for leadership. Klara Gordon followed their call. Over the next four decades, she went on to build the nursing division of the Israelite Hospital in Hamburg, a nurses’ residence, as well as the state-approved nursing school in 1908. In her, we see an example of both the entrepreneurial spirit and the principle of networking. At the end of. By this time, after a brief decline in the early 1920s, the enrollment numbers in nursing education were rising, the curriculum had been significantly refined, the duration of the training had been extended to two years. From the period oft he Weimar Republic, introduce you to Thea Levinsohn-Wolf. Born 1907 in Essen, she joined the nurse training program at the hospital of the Israelite Community in Frankfurt in 1927. She had defended this choice against the will of her parents, who had envisioned a life as a wife and mother for her. After completing two years of training, she graduated with excellent results in 1929 and began working in the women’s surgical ward. [38] As already mentioned, Frankfurt held both a magnetic as well as a signaling effect. In 1932, the Jewish community of Alexandria was in urgent need of trained personnel. Dr. Fritz Katz joined from Frankfurt together with Thea Wolf, whom he had come to know as a competent nurse. Following the Frankfurt model, she established a nurses’ residence on the grounds of the new Jewish hospital in Alexandria, while also taking the position as head nurse of the hospital’s surgical ward. In this function, she was able to provide support to many Jewish refugees from 1933 onward. Originally, the plan had been for her to return to the hospital of the Israelite Community in Frankfurt after two years, so in 1934. However, due to the Nazi takeover, she remained in Egypt. Later she moved to Palestine. In Frankfurt I had the opportunity to meet her. Thus, even as Thea Levinsohn-Wolf was establishing a system of Jewish nursing care in Alexandria, the Nazis were drastically cutting back the rights of Jews living in Germany, culminating in deportation and genocide. It is very difficult to reconstruct the life circumstances of the Jewish nurses, since many sources were destroyed. Fortunately we have documents registering the inhabitants of the Jewish Nurses’ Residence and the hospital of the Israelite Community. From the wealth of data, I would like to highlight the topic of emigration: Of 262 persons registered, 59 were able to emigrate. The country of emigration is noted for 53 of them: England is at the top of the list. You can see on the list one person who emigrated to Argentina. I have met the daughter of this nurse, and am indebted to her for tales and photographs from her mother’s life. Toni Spangenthal was born on January 1st, 1911 in Spangenberg, Northern Hessia. On July 31st, 1931, she moved into the nurses’ residence in Frankfurt to begin her training. In Frankfurt, she met her future husband Alfred Berg (born 1910). He was forced to leave for Argentina as early as 1936, due to severe antisemitic discrimination. Luckily, he was able to get Toni to Argentina 1938. Their children Silvia and Angel were born in 1941 and 1943. The family had to live in the harshest conditions in the countryside. Tonis certifications were not recognized, she was forced to work illegally as a private nurse. At first, the children were placed with an aunt and uncle in the countryside, while their parents remained in the capitol to earn money. It took several years before the family could move to Buenos Aires together and the daughter Silvia could attend school. As soon as she turned eighteen, Silvia immediately left for Israel, where she began her training and worked in several capacities of nursing with great joy. Bibliography 1. Das Gumpertz`sche Siechenhaus - ein "Jewish Place" in Frankfurt am Main. Frankfurt 2019 [39] Portuguese Nursing between 1910 and 1933 – The Construction of a Professional Identity Ana Maria Pires1, Lucília Mateus Nunes2 1 School of Health, Polytechnic Institute of Beja, Portugal; NURSE'IN, Nursing Research Unit for South and Islands; 2School of Health, Polytechnic Institute of Setúbal, Portugal; NURSE'IN, Nursing Research Unit for South and Islands Throughout time, society has associated contradictory representations of nurses and nursing, which persist in the individual and collective imaginary. Social representations are part of a memory, more or less distant, and may have an historical, social and cultural justification. Therefore, we defined as the main goal of our study to reveal how social representations associated with nurses and nursing appeared in the past seeking the path of our professional identity. The temporal limits of the study are between 1st Republic beginning (1910) and the promulgation of the Constitution, establishing the political principles, which defined “Estado Novo” (1933). The research developed according the following guidelines: 1. Identification of sociopolitical, cultural and sanitary context (facts only make sense in their relation with various factors) 2. Identification of legal diplomas concerning the profession (legal diplomas reflects the needs and problems of a society and the ideology that sustained its construction) 3. Identification of the representations related to nurses and nursing To answer the questions of each topic, we used: 1) Generalist daily press to identify news related with nurses and nursing (“Diário de Noticias, the most sold newspaper at the time); 2) Legislative documents and 3) minutes of parliamentary debates. Conceptual assumptions of discourse analysis and specifically the concept of interpretative repertoire were the base to analyse documents corpus. Before we mention the findings (interpretative repertoires) must refere some Portugal characteristics at that time. On the morning of the 5th October (after 700 years of Monarchy) the Republic “found” a country financially exhausted, with an illiterate population, rural, and poor, with a significant rate of emigration and also migration to big cities (at the time Lisbon and Porto) looking for a better life.The republican ideals bring hope of a society built on justice, progress and science, where women and men, citizens, were educated, responsible, vigorous and patriots. But the sixteen years 1st Republic lasted were marked by political instability, opposition movements to the new regime, popular rebellions and, most of all, by the 1st World War that make even harder the living conditions of Portuguese people and brought increase prices and difficulties on food supplies and stuff. Constant instability support a dictatorial solution that occurs on the 28th may 1926, after a military coup. Between 1926 and 1933 the instability remains; from 1928 onwards, Salazar, first as finance minister and after as prime minister, defined the ideological and political assumptions of “Estado Novo”, the fascist regime that will remain 48 years. During the 23 years, studied, Portugal regularly experienced epidemic outbreaks of smallpox, typhoid, and cholera. Scabies and rabies were a constant. Tuberculosis never stopped increasing on a population with severe food shortages and bad hygiene habits. Child mortality reached rates of 130/1000. Hospital care conditions were precarious due to deficit budgets; too much seek people, and building and equipment degradation. The result of analysis done to the documents we gathered, allow us to identify patterns of language that define five interpretative repertoires used to describe nurses and nursing. 1. NURSE AS A MAID AND NURSING AS A FEMININE OCCUPATION Several discursive excerpts point out the association between nursing and housework and the role of woman at home. Found words like servant, housekeeper, chaperone and expressions like “knows everything about housework” mainly on advertising asking for or offering nursing services. Some characteristics, associated to feminine figure, are point out such as be loving, be clean, to know how to rule a house. Nursing is associated with the role of a woman at home, is a feminine occupation that could be done by humble and less educated people.Concerning personnel who work at hospitals we identified a discourse that devalue nurses considering them uneducated, bad character persons, capable of stealing, and mistreatment patients, without the qualities related to a good nurse such as knowledge, discipline, affection and devotion.This rational was used to defend the presence of religious nurses at the hospitals and later to defend the exit of nurses from army after 1st World War. Nevertheless, we also identified an opposite discourse that points out the effort and self-denial of nurses that works in inhumane conditions with such low incomes that were not enough to daily needs. Mainly physicians produced such discourse claiming for better salary and education for nurses thus persons with the moral qualities demanded by the profession could practice it. 2. THE ENHANCEMENT OF NURSES AND NURSING IN THE CONTEXT OF REVOLUTIONARY FIGHTS AND 1ST WORLD WAR Several discursive excerpts referring nurses and nursing under rebellions occuring in the country and under 1st World War. The news that describes such situations praises the work and qualities showed by nurses. [40] The effort, self-denial, care, devotion and affection showed by nurses while treating the wounded is highlight. Professional conscience is point out since nurses’ runs to the hospital even being off to help the treatment.Is the 1st World War that brought to light nurses. Portuguese Red Cross and a feminine movement created at the time “The Portuguese Women Crusade” led the effort of organize a nurse corps well prepared to work both in Portugal and in France. Concepts such as patriotic duty and humanitarian mission were the base to the call done to Portuguese women to sign up the war nursing courses. At the same time, characteristics so called feminine, were highlighted such as kindness, devotion, affection, patience and compassion. A strict moral behavior was imperative. It became a profession approved by a diploma. 3. THE ENHANCEMENT OF NURSES IN THE CONTEXT OF THEIR INTERVENCIONS After the war became evident the relation between poor living conditions and the onset of certain diseases.It is underlined the importance of prevention and the need of educated professioals. Appears texts were nurses were referred as the indispensable collaborator of doctors with an education role.Their education and personal qualities allows them to be agents in changing people’s behaviors towards diseases.The role of nurses on community underline the need of educated visiting nurses like on civilized countries. 4. THE ENHANCEMENT OF NURSING IN THE CONTEXT OF LEGISLATIVE BODY The legislative documents we found show a continuous concern on valuing the profession throughout reformulation of admission criteria both to school nursing and to hospital. Although there was, a “Professional School of Nurses” since 1901 at Hospital S. José (the biggest in Portugal and in Lisbon) nurses training was not so good: there were no skills examinations to candidates; the only demand to candidates was to know how to read, write and count. Anyone could be admitted as a nurse. In 1918, a law defined the reorganization of Public Hospitals in Lisbon and of the “Professional School of Nursing”. In newspaper we can read nurse staff, admission criteria, rules of promotion that depend from now on of public examination, moral suitability and proof of skills. From 1918 on, we identify on legislative documents an increasing demand: for better academic qualifications; for defining skills criteria and moral suitability both to admission and to career development and for good behavior as a requirement to access to nurse staff. Nevertheless, in the hospitals, continue to work, as nurses, people that had no diploma and, per some testimonies, of doubtful behavior, despite all legislative effort. 5. THE ENHANCEMENT OF NURSING IN THE CONTEXT OF EDUCATIONAL TRAINING – the presence of professional nursing school on the newspaper Nursing school had a regular place on newspaper, refering, most of all, formal sitting when school opened, the beginning of school year and distribution of prizes to students.The ambience, the speeches and the individualities present were described in detail. Therefore, nursing education is showed as rigorous and demanding; students were engaged and qualified therefore they were awarded. The transcription of speeches shows the compliments done to students by their teachers ensuring their competence. We point out as conclusions: • • Nurses and nursing were visible on newspapers, legislative documents and parliamentary sessions; Republican ideals brought laic nursing to light; beliefs in the value of science compelled nursing to become a socially valued profession with skilled professionals and irreproachable behavior; • 1st World War was a turning point in Portuguese nursing - from 1918 onwards legislative production proposes profession regulation and a higher demand for its education; • In 23 years, nursing passed from a profession practiced by undifferentiated personnel to a profession that need a diploma obtained in legally recognized schools. Nurses passed from “maids” to qualified professionals; • Nursing became a feminine profession and gained a communitarian side, needed for the struggle for better sanitary conditions in the country; We believe this work can add to the reconfiguration of our past.The recovery of memory gives us cohesion and a sense of belonging to a professional group enabling us to build our professional identity. History is a path that always begins with a curiosity, a question. Answer that question like “What happened?” and “Why it happened?” allow us to understand the making and transformation of societies over time giving social groups a sense of identity and permanence. With no memory, we simply do not exist! Bibliography 1. 2. Pires, A (2013) Ser Enfermeira em Portugal. Da I República à Instauração do Estado Novo (1910-1933). Leituras na Imprensa Generalista. Nursing PhD thesis. Universidade Católica. Available in <https://repositorio.ucp.pt/handle/10400.14/12101>;;. Nunes, L.(2009) Um olhar sobre o ombro. Enfermagem em Portugal (1881-1998). 2nd ed. Loures: Lusociência. ISBN: 9728383-30-4. [41] Mental health nurse: professional evolution through narratives - the Trieste experience Claudia Fantuzzi, Giuliana Pitacco, Daniela Babich, Cristina Brandolin, Giorgio Lo Nigro, Gabriella D'Ambrosi, Roberta Accardo Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI), Italy Background The work that famous psychiatrist Franco Basaglia and his collaborators have undertaken in Trieste since the 70s in restoring dignity and rights to people with mental disorders, led to the final closure of the Psychiatric Hospitals and to the foundation of the Community Mental Health Care, according to what established by the Italian Law 180/78. Much has been written about this reform, but only in few cases special attention has been paid to the nursing role. To highlight the importance of our profession within the psychiatric revolution and in the mental health care, we started with a phenomenological analysis using nine interviews with nurses we found in the historical archive of Trieste’s Mental Health Department. Two researchers, in the early 2000s, had interviewed nurses who had been actively involved in the closed psychiatric hospital first, and in the new open system later, asking them about their role and their feelings. It emerged clearly that the nursing role had changed a lot due to the reform, since Basaglia gave freedom not only to the asylum inpatients, but also to their nurses, granting them a professional autonomy still almost denied to nurses in other care settings, like the general hospital. Since then, the professional laws and the socio-political context have been constantly changing and in recent decades we have noticed a growing care complexity leading to a strong demand for professional integration between health and social workers. Aim and objectives With the broader goal of redefining the nursing role in the Trieste Mental Health Department (MHD), this study aims at identifying the basis of the skills of the mental health nurse in Trieste, starting from 1978 until today. Methods Our previous phenomenological analysis on the nurse’s role has shown that the psychiatric reform implied dramatic changes and it should be seen as a starting point for a broader reflection on the current role of the mental health nurse in Trieste. We carried out a qualitative research, comparing two groups of nurses that differ by age, formal training and working experience in Mental Health. The first group of so-called “old nurses”, with non-university nursing training, attended to an experiential workshop, while the second group of newly trained nurses, with university nursing degree, attended to a focus group. We obtained permission from all participants to record each meeting for further analysis. Experiential workshop (EW) We invited 16 nurses who have worked in the MHD since ’80s or ’90s and 9 of them accepted to attend (six men and three women). Three of them have retired in the last 10 years, one has moved to another department in the same Health Agency and five of them are still working in the MHD; four of them held nursing coordinator roles, while one of them can be considered as an outsider since she has worked also in the asylum. All attendants have been working in MHD for at least 25 years (range 25 – 42 years) and they represent the second wave of the Basaglia Reform (80s, 90s and 2000s). There were two moderators with no experience in the field of mental health and six researchers belonging to the MHD as observers. We invited participants to write their own work experience and share it during the workshop in order to reconstruct the collective memory of MHD nurses. The discussion lasted 5 hours and turned out to be an exciting and highly participated experience, because attendants already knew each other and they were happy to meet again after so long. Focus Group (FG): We invited seven nurses (four men and three women) who have been working in the MHD for up to 6 years, chosen among colleagues that internal researchers believed were most actively involved, with one outsider (because she has been working in the MHD for 15 years). Nobody had a formal specialization in Mental Health and they did not know the two moderators (the same of the previous experiential workshop), because we wanted to offer them the maximum freedom of expression. Stimuli proposed by the moderators involved a review of the participants’ mental health department history, a description of their initial impact (narrating the experience itself with related pros and cons), and suggestions about what could be improved in the MHD organization. The FG lasted two hours, with a very different atmosphere compared to the EW because some participants did not know each other yet, and they used the focus group almost like a vent. Results We found some important differences between the two groups. On the one hand, during the EW, we were able to feel the enthusiasm for the new model of mental health care, while during the FG we noticed unmet expectations regarding the recognition of the role within [42] the care model. Now the nursing students of the University of Trieste study the Basaglia Reform and the importance of nurses as case managers in MHD, and perhaps sometimes they are not in the position to experience what they read in the books. The "old nurses" told us about the "wave of change" they perceived when "they were making history"; while today, there is a different model of continuity of care, due to the laws, to the socio-political context, but also to the professional development. Participants to the EW group, in fact, have been able to choose what to do and to create new care paths during their work experience, while participants to the FG group encounter some difficulties in managing certain behaviors due to a different awareness of role and responsibilities. The "old nurses" had a strong sense of belonging and resolved their conflicts within the group, while now the "new nurses" ask for formal supervision, perhaps because they do not feel they belong to something "great". Both groups believe that the relationship is the most important aspect of the HD nurse's job and that nurses should improve their communication skills. Discussion Those we mentioned above are not the only differences between the two groups: in the past 40 years, the legislative process has led the nursing profession to become an independent profession with a growing professional responsibility. Naturally, nurses, therefore, ask for a better salary and a real autonomy in care decisions (and not only on papers, as often happens). In addition, data on MHD activity show that in 1978 there were 1100 hospitalized patients and in 2018 there were approximately 4800 people in contact with the mental health services, while the nursing staff had decreased from 300 nurses in 1978 (with a nurse-patient ratio of 1: 3, regulated by law) to 111 in 2018 (without personnel standards by law). In half of the cases, MHD clients suffer from a serious psychiatric disorder, with the need to build networks between other social and health services. Now nurses often feel replaced within their particular role in MHD by other professional figures (occupational therapists, educators, sometimes psychiatrists and psychologists, nursing assistants ...), and relations with such professionals and other services are sometimes conflicting. Professional responsibility has also increased, with additional bureaucratic tasks and less time to dedicate to people in need. Some old nurses say that "mad people are not the same as before", because nowadays they are more aware, more informed but also affected by more comorbidities, especially misuse of substances. Today there is an emerging problem related to the safety of health workers and the risk of bringing back the timeless stigma about the danger of people with mental disorders. Conclusions Our research highlights various problems to deal with, in order to recreate the favorable working environment experienced by the EW team. First, it is essential to increase the nursing staff, to reduce the perception of a too heavy workload and to meet the real needs of the clients. At the same time, we should work to increase group management and team building, also helping our new nurses to work on themselves with a deep self-reflection on their role, on their emotions in dealing with this type of client, and on their expectations from their work. We still believe in the quality of the organizational culture created by the Basaglia reform and should obviously share it, implementing audits with the entire professional team on a regular basis and identifying expert formal tutors to whom new operators could turn and who could be taken as a role model. We need a brand new reflection on the job description of the mental health nurse and we need specific training for this figure, with onthe-job training, specialization courses and university masters. Of course, further research is needed, particularly on the perception of the nursing role not only by nurses, but also by other professionals within the team, and this will be the foundation on which to build. Bibliography Original Work [43] The role and image of nurses during the post-fascist period in Italy through the advertisements of a professional boarding school for nurses Silvia Cilluffo1, Barbara Bassola2, Maura Lusignani1,2 Università degli Studi di Milano, Italy; 2ASST GOM Niguarda, Milano, Italy 1 Introduction In Italy of post-fascist period, nurses were educated in the professional boarding nursing schools, “Scuole Convitto Professionali”, that were instituted in 1925. The course was a two-year theoretical and practical course with a related internship, after the first two years another year could be added to obtain the qualification for the managerial functions. Only women, aged between 18 and 35, with a middle school certificate, could apply. The teaching was carried out by accredited doctors, the director and the chief nurse. The director of the boarding school was a nurse in possession of the qualification for managerial functions. After fascism, after second world war, after the universal suffrage in 1946, Italian women were trying to come out of the role of womanmother to which they were relegated during Fascism and to conquer a place in society. The average level of schooling was the elementary one and given the extreme widespread poverty, working opportunities were very limited. Nursing school offered an opportunity for high-level free education and work, but they had to promote themselves and through advertising they tried to convince young women to choose to become a nurse and to apply to nursing courses. Purpose Investigate how nursing schools advertised themselves and the role of nurses after 1945 in Italy. Method An historical document analysis in the archive “Nursing School of the Niguarda Ca’ Granda Hospital” in Milan was conducted. We analyzed the documents found inside the folder “Announcements of the professional boarding school” dated between 1946 and 1962 and conducted an external and internal analysis of the sentences describing the nursing school and the role and image of the nurse. Findings The documents found were 34: 13 requests of advertisements sent to newspapers / periodicals, 2 requests of advertisements sent to radio stations; 5 announcements and 2 draft; 5 lists of newspapers, periodicals, radio broadcasters; 3 letters sent to school directors; 3 excerpts of newspaper 1 notice that lists access requirements for the boarding school. Authenticity and truthfulness were verified by analyzing protocol numbers, original stamps, the paper and the ink used, names of signatory directors and of periodicals. All documents within the source were on yellowed paper, typewritten and signed by nurse director and medical director. In a letter sent by dr Sollazzo, Hospital director, to a middle school director, inviting him to introduce the school to his students, the advertisement was addressed to: "young ladies of good family, provided with a certain degree of preparatory education, animated by noble sentiments of altruism”. The school had as an objective to educate nurses according to current legislation. The hospital in which the nursing school was, was described as “equipped with every comfort, modern hygienic installations, bathrooms, a sport hall, recreation rooms, large classrooms, a library". Nurses were presented as "well-trained and prepared female care staff", with the adequate financial treatment and regular duty shifts. It was underlined the possibility of "hiring in the hospitable service to the best students at the end of the course". The request of advertisements sent to newspapers and periodicals are 13: 7 signed by the director of the boarding school and Hospital health supervisor dr Sollazzo, 6 signed by the director of the Nurse School Sister Emilia Vinante. In an announcement, dated 1946, the list of access requirements for the boarding school agree with the legislation and the school is advertised as a two-year technical and practical course, aimed at women between 18 and 35 years old, in possession of a middle school certificate, the possibility of the third year for managerial functions was also announced. A second announcement, dated 28 July 1949, declares the opening of registration for the two-year course and describes the requirements for access as the previous one. It also highlights the possibility of "hiring in the hospitality service for the best subjects at the end of the course". In a third notice (not dated), the text is like the previous one with corrections in pencil next to "middle school certificate", to which is added "or equivalent title". The word "possible" is added at the beginning of the sentence related to recruitment and the words "to the best subjects" is canceled in pencil. In an announcement by an Italian radio station was reported the free course and the possibility of immediate recruitment at the end of the course. All the announcements and the advertising analyzed reported the same description of the school and the access requirements, except for one document: this announcement, dated 22 August 1962, it indicates that the access age is 19 years. The newspapers, periodicals and radio stations resulting from the three lists analyzed, to which the announcement was sent, were from all regions of Northern Italy. [44] Discussion After the events of the Second World War, the need for health was more perceived and the "hospitalization needs" of people had increased, especially those belonging to the least wealthy classes. Nursing care was carried out only within hospitals. The analyzed documents describe how the nursing schools advertised themselves and the role of nurses between 1946 and 1962 in Italy. The changes found during the twenty years analyzed were not relevant. The contents correspond to the legislation of the time. From the sources it emerges the image of the nurses and the nursing care of the time. The Nursing School aimed to a "dignified and meritorious profession never seen before" and was offered to "young ladies of a good family, equipped with a certain degree of preparatory education, above all animated by noble sentiments of altruism". The Nurses School were advertised as providers of theoretical and practical preparation with a high level of competence. The school included a professional preparatory training for working life. The concept of continuity between the nursing school and the hospital also emerges, and even the notices concerning the applications to the school promised recruitment opportunities within the hospital. Conclusion In the post-fascist period, nursing schools prepared well trained nurses, purely hospital-oriented, and advertised them as “a dignified and worthy profession never seen before". Bibliography 1. 2. 3. 4. 5. 6. Historical archive. “Nursing School of the Niguarda Ca’ Granda Hospital”. Available on page: https://laureainfermieristica.ospedaleniguarda.it/archivio_storico Bezze, S., Manzoni, E. & Di Mauro, S. (2013) Il contributo allo sviluppo della professione infermieristica delle congregazioni religiose del XIX secolo. Professioni Infermieristiche, 66 (2): 75-84 doi: 10.7429/pi.2013.662075 “Memorie della Scuola” I (1930 - 1963). In Statuto, regolamento e memorie (1930 - 1996). Sezione “Amministrativa” Segnatura 30. “Nursing School of the Niguarda Ca’ Granda Hospital”. Available on page: https://lombardiarchivi.servizirl.it/fonds/37048/units/518308 Regio Decreto Legge (Law) 15 agosto 1925, n. 1832 “Facoltà dell’istituzione di scuole-convitto professionali per infermiere e di scuole specializzate di medicina, igiene pubblica e assistenza sociale per assistenti sanitarie visitatrici” Regio Decreto 21 novembre 1929, n. 2330 “Approvazione del regolamento per l’esecuzione del R. decreto-legge 15 agosto 1925, n. 1832, riguardante le scuole-convitto professionali per infermiere e le scuole specializzate di medicina, pubblica igiene e assistenza sociale per assistenti sanitarie visitatrici”. Sassi, G. (2014) Scuola Infermieri dell’Azienda ospedaliera- Ospedale Niguarda Ca’ Granda. Biografie. Available on page: http://lombardiarchivi.servizirl.it/creators/3864 [45] Anhela Boškin, The Beginner of Nursing Care in Slovenia Irena Keršič, Darinka Klemenc, Marjeta Berkopec, Monika Ažman Nurses and Midwives Association of Slovenia, Slovenia The article presents the character and work of Angela Boškin, the first educated nurse in Slovenia, her schooling, career, her contribution to the development of the profession, education and professional association of nurses in Slovenia or to the then state of the Kingdom of Yugoslavia. Method of work: The data were obtained through a descriptive retrospective survey method, from available literature, especially the bibliography and published articles, by reviewing her legacy owned by her relatives, examining her legacy, from the interview with Angela Boškin, presented by national television, and from a review of archives kept by the Nurses and Midwives Association of Slovenia. Angela Boškin is recognized as the precursor of today's nurses in Slovenia and also in ex-Yugoslav region. With the start of employment in 1919, she laid the foundations for the development of modern nursing and the profession of nurse in Slovenia. She is considered as the initiator of not only a nursing care but also of a social care. In terms of content and forms of work, she was the forerunner of today's community nurses. In Vienna, she received training in nursing and social care for children, mothers and newborns, healthy and sick, fieldwork and counselling. She was born in Piuma near Gorizia (Italy) on 6th June 1885. Her parents were Slovenian; father Franc was a blacksmith, mother Marija took care of the household and many children. They were working hard to get their children educated. In 1905 she went to her brother in Vienna, where she helped with the shop. In 1912, at the age of 27, she was accepted among nursing school students in Vienna as a pupil in the Wertheim’s Clinic neonatal ward. The training program was divided into practical work with the patient and theoretical part - listening to lectures. After two years of learning she was the assistant of gynaecologist dr. Wagner for one year. During World War I in 1915, she was assigned to work in the Convalescent Department of the Military Hospital and in the same year to the Swedish Mission's health team at the International Red Cross Hospital. In 1917, she was named head nurse at a reserve military hospital, the location is unknown. She lived in very modest conditions. She paid special attention to the individual employment of patients, devising time for them by preparing small celebrations. In Vienna, she learned that the Ministry of Health and Social Welfare of Austria was setting up a new school for health and social work. There are no accurate data on Angela Boškin’s enrolment and education in Vienna. Information obtained certificate or diploma are contradictory. She received the title caregiving nurse, children caregiver, and has made her decision for the field of maternal and child care. In 1918 she returned with soldiers and refugees from Vienna to Ljubljana. The employment and work of a nurse practitioner on the territory of Slovenia in the Kingdom of SHS was hampered by two things: there were no health-social-care institutions and nuns operated in hospitals. By decree she was placed on the position of care giving nurse in Trieste. The dissolution of the monarchy overturned the decree. On January 27th 1919, a decree was issued about setting up a care giving nurse in Jesenice. On February 3rd, 1919, Angela Boškin began working. The date also signifies the day of the rise of the profession of nurses in Slovenia. She proposed and established the first Counselling Centre for Mothers and Children (August 1st, 1919), and was part of the "children's home", as it was called the nursery. She introduced rental baskets, performed health education work, and put into practice Victoria Kecelj, a future child protective nurse. Angela left Jesenice in May 1922 and went to Ljubljana, where she set up a children's shelter. In August 1923, the Ministry of National Health set up a school for (protective) nurses at the Institute for Social and Hygiene Protection of Children in Ljubljana, which began with lessons on January 3rd 1924. In 1924/25, Angela was a student at a newly established school and at the same time a mentor and teacher to other students. 13 graduates of the School of Nursing and Angela graduated with a diploma, attesting a certificate from Vienna. She received the title child protective nurse. In 1926, in accordance with policy of sending educated nurses to smaller towns and to the countryside, Angela Boškin was sent to work in the Consultative Centre for Mothers and Infants in the mining town of Trbovlje. The exceptional work of the nurse practitioner was carried out here from 1926 to 1936, with 2200 first home visits and 4900 re-visits in addition to counselling and health education work. In 1939 she returned to Ljubljana and worked at the Institute of Hygiene. She has directed travelling exhibitions throughout the villages, with lectures and propaganda films. In the same year she was transferred to Škofja Loka, where she was indispensable in establishing a dispensary for the treatment of tuberculosis, which began its operations in 1940. She has delivered health education lectures in schools and villages and participated as a lecturer in household courses. Once a week she went to another working place in Kranj. There are oral sources describing Boškin's in Škofja Loka as a kind lady, sloppy figure, with shadows of lightly grey hair, usually covered with dark blue beret, with extensive knowledge and very educated. She remained in Škofja Loka until retirement. Her contribution to the emergence, organization and management of a professional nursing organization is important. On November 27th, 1927, the founding assembly of 13 graduates of the School for Nurses of the Institute for Social and Hygienic Protection of Children in Ljubljana was held, who founded the Organization of Graduate Students of the School for Nurses in Ljubljana, the first and only nurse association in the Kingdom of SHS at that time. Boškin took over the management of the organization practically since its foundation, as president-elect Antonija Schiffrer was transferred to Belgrade in January 1928. Angela was officially elected at the 2nd General Assembly on October 7th, 1928, and led the renamed Organization of Graduate Protective Nurses in Ljubljana until April 11, 1937. She participated in addressing key issues in the emerging profession: nursing school curricula in the Kingdom of SHS, complementary studies of nursing graduates, introducing guidelines for organizing professional nursing organizations according to international [46] standards, discussing the name of nursing care providers, initiating initiatives to improve their financial status and becoming involved in feminist organization Women's Movement, which aimed at the civic and social equality of women. She emphasized modesty and engaged in a lively debate with her colleagues about the grey colour of the nurses' uniforms. The records show that this was the only time she was strongly opposed. With the renaming of the Kingdom of SHS to the Kingdom of Yugoslavia, as a consequence of the amended legislation and the need for state-level unification, Angela participated in the preparatory committee of the Yugoslav Society of Graduate Nurses in 1929 in Zagreb. During this time, the professional organization was admitted to the International Council of Nurses. The legacy of preserved documentary and pictorial material left behind by Angela Boškin is scarce. The question arises as to whether nurses in the past have been too modest in appreciating our own history, which we have painstakingly created. The articles she published in the journals Sestrinska riječ and Ženski pokret today represent important historical material. On the occasion of the 50th anniversary of the work of the first nurse in Slovenia, national television in 1969 recorded the show Meeting with Angela Boškin, which is a rare important preserved record. She speaks about her life experience, profession, fieldwork, care for healthy and sick children, social and hygienic conditions and values, that is, the essence of nursing. In 1969, for the first time, the National Nurses Organization awarded the highest honours to deserving members. Angela received the Gold badge and the Golden plaque for her pioneering work and outstanding achievements in the field of professional development, promotion of the profession, leading a professional organization, moral ethical values and contribution to the development of healthcare and activities in Slovenia. She retired in 1944 and returned to her native Pevma, which remained under Italy after World War II. She died on July 28th, 1977, at the age of 92 and is buried in Pevma. Angela Boškin was constantly improving herself, reading philosophers and educators, castigating herself for lack of knowledge, she loved the mountains and nature, was deflecting light-headedness, defended the need to approach people and was proud for breaking new ground of nursing, professional organizations and nursing education in Slovenia. She monitored life around her and highlighted knowledge one can acquire and health, all the more important to him at an advanced age, as the greatest values. She estimated that the times in the 1970s were, however, friendlier to nurses, who were no longer so burdened, and could afford serious study, in-depth scientific work, the cultivation of art, family and more. Bibliography 1. 2. 3. 4. 5. 6. 7. 8. Archive of Nurses and Midwives Association of Slovenia. Archive of DMSBZT Ljubljana. Boškin, A., 1935. Zaščitna sestra v delavskem okraju. Sestrska riječ, 7-9. Keršič. I., Berkopec. M., 2017. Nagrade in priznanja, ki jih podeljuje strokovna organizacija. In: D. Andoljšek, I. Keršič, D. Klemenc, M. Berkopec, A. Mihelič Zajec, et al., eds. Negovanje dediščine skozi devet desetletij – organizirano delovanje medicinskih sester na Slovenskem. Ljubljana, Zbornica zdravstvene in babiške nege Slovenije – Zveza strokovnih društev medicinskih sester, babic in zdravstvenih tehnikov Slovenije, pp. 300-310. Keršič, I., Klemenc. D., 2017. Ustanovitev, organizacijske sheme in žigi. In: D. Andoljšek, I. Keršič, D. Klemenc, M. Berkopec, A. Mihelič Zajec, et al., eds. Negovanje dediščine skozi devet desetletij – organizirano delovanje medicinskih sester na Slovenskem. Ljubljana, Zbornica zdravstvene in babiške nege Slovenije – Zveza strokovnih društev medicinskih sester, babic in zdravstvenih tehnikov Slovenije, pp. 25-36. Keršič, I., Klemenc. D., Berkopec. M., Seničar. Z., 2017. Predsednice strokovne organizacije. In: D. Andoljšek, I. Keršič, D. Klemenc, M. Berkopec, A. Mihelič Zajec, et al., eds. Negovanje dediščine skozi devet desetletij – organizirano delovanje medicinskih sester na Slovenskem. Ljubljana, Zbornica zdravstvene in babiške nege Slovenije – Zveza strokovnih društev medicinskih sester, babic in zdravstvenih tehnikov Slovenije, pp. 84-87. Korenčan, A., 2009. Življenje in delo Angele Boškin, prve šolane medicinske sestre na Slovenskem. Strokovna monografija. Gorica: Goriška Mohorjeva družba, pp. 17-60. Podgornik, J., 1970. Srečanje z Angelo Boškinovo. Oddaja RTV Slovenija. Ljubljana, 8. marec 1970. [47] International Contribution to Nursing in Malta. Catherine Sharples University of Malta, Malta Dr Catherine Sharples, PhD (Nursing) Nursing in Malta has always been managed by the governmental authorities. This is in contrast to many other countries where religious orders traditionally took care of the sick. In Malta, since the opening of the first hospital in the 13th century, the government of the time provided equipment, personnel and maintenance of patients to the best of their ability. This work refers the era of British Rule (1800 – 1964) and the post-Independence era. The title ‘nurse’ was first mentioned in the official documents in 1860.[1] At the time, nursing personnel consisted of Servants, Attendants and Nurses and one could be promoted from one category to another. Requirements to enter gain such employment are also not clear and documents show that an assistant cook was ‘promoted’ to the post of Nurse, an orphan girl was employed as a nurse to offer her shelter, a carpenter was made a nurse and a police constable who was found unfit for his duties was offered nursing as an alternative employment.[2] The difficult task of finding the right people who would nurse was left to the Comptroller of Charitable Institutions and one occupant of this position after another expressed this difficulty. Nursing personnel were difficult to find and many of them left soon after being appointed, such that Comptroller F.V. Inglott was on the verge of resigning his post at being repeatedly unsuccessful in employing ‘good’ nurses. The Comptroller’s correspondence at the National Archives is full of instances where nurses, attendants and servants were reported for bad behaviour including thefts, abuse, ‘amorous mischief’ and neglect of duty often leading to dismissals.[3] One physician described the situation as a ‘confusion in the nursing part of treatment.’[4] Inglott sought assistance from beyond Malta’s shores. He asked the Sisters of Charity to come to Malta and assist first with taking care of the Orphans and then with nursing, acting upon the suggestion of the retiring Superintendent of the Orphanage.[5] The Superintendent may have been au courant with the fact that the Irish Sisters of Charity had gone to Australia to nurse, and missionaries were setting nursing facilities in Pakistan[6] and India.[7] The Sisters of Charity came to Malta from Rome and were soon running all the charitable Institutions in Malta, a situation that was to continue to 1970s. This was not an easy ride for Inglott as the authorities could not believe there was such a need quoting the adage that: ‘..there are as good fish in the sea…’ Inglott replied that Malta was a peculiar place in this aspect or that he was not acquainted with the right bait.[8] The British Matron, was fit for the position but the Comptroller exclaimed ‘..where can I obtain another one?’[9] The Colonial Nursing Association had not yet been founded. The difficulty may have arisen as this was a Protestant government which was inviting Catholic nuns to run their hospitals. The arrival of the nuns was a move which was regarded as ‘an admirable innovation.’[10] However, the behaviour of the nurses persisted in being undesirable,[11] irrespective of repeated efforts to train nurses formally, the issue of a book in the Maltese Language[12] and the nuns’ practical training of nurses in an apprentice style training.[13] The low social status of people who would nurse and their general lack of education were blamed for this lack of success.[14] The numbers of certified nurses remained small.[15] Training was offered to men only, since female patients were nursed by nuns.[16] A private school for nurses was founded providing such an education to women who were not government employees. It was run by the English Little Company of Mary; nuns who had been especially founded to provide trained nurses.[17] There is little evidence that Maltese nurses contributed to the nursing of around 60,000 sick and wounded soldiers arriving in Malta during World War 1. British nurses and VADs were responsible for this. However, there may have been lasting impressions of the orderly way in which nursing was carried out then. The efforts to improve nursing in Malta continued but were still not as fruitful as desired.[18] Once more, the authorities had to look beyond their shores. In 1938, the governor, Sir Bonham Carter travelled to London to discuss what he called ‘our nursing problem with the General Nursing Council which recommended that 12 young women would be sent to England for training in various hospitals.’[19] This was similar to arrangement undertaken up by Pakistan in 1947.[20] Meanwhile, the new St. Luke’s School for Nurses was opened in 1938 led by an English-trained Sister Tutor Ms. M. L Doherty.[21] Ms Doherty may have been sent by the Colonial Nursing Association; one of several nurses from Britain who were deployed to several countries to ensure the success of government hospitals throughout the Empire.[22] It was suspended during World War II resuming under the helm of a qualified Maltese nun who was to remain in post for 40 years. Training in nursing followed that predominant in Britain, mostly through an apprenticeship method supported by lectures delivered by physicians and surgeons. The number of lay students who finished the three-year course for registration remained small possibly due to: a general lack of education that was more prominent in women, the length of training and the lack of opportunity for lay nurses to advance in their careers. Management posts were reserved for the Sisters of Charity and a British Matron, a situation that was similar to that in other colonies such as Jamaica where managerial positions were held by British trained nurses in 1948,[23] and Pakistan, where local nurses were not considered for high positions.[24] The number of students gradually increased. After Independence in 1964, the advance of technology and progress in the medical field were pressing for changes in nursing. Expertise was sought in the UK and Belgium where nurse followed courses in high tech areas. British nurse formed part of specialised teams visiting Malta to perform operations. A gradual upgrade began but progress was slow. In 1988, the Maltese authorities looked for assistance from abroad in reporting on nursing education and placing nursing education on a tertiary level. This included scouting for Universities which would cooperate with Malta in this endeavour, even though the number of these Universities was small. Agreement was reached with the University of Liverpool to adopt its undergraduate programme. The University of Manchester was later to provide a programme for students who were already nurses. Both educational institutions sent lecturers to Malta who stayed until Maltese lecturers could replace them. [49] Nursing in Malta has since sought to maintain high standards of education and practice with the contribution of foreign institutions where our nurses regularly attend for undergraduate and post graduate courses and practice placements. This has been greatly facilitated by Malta’s accession to the EU in 2004. References [1] Letters to the Government 7.1.1859-31.12.1861 p 125 NAM [2] Register of References to the Comptroller of Charitable Institutions (NAM) Code Nos 2 – 7 [3] Register of References to the Comptroller of Charitable Institutions National Archives of Malta (NAM) Code Nos 2 – 52, [4] Inspector’s letters to Chief Secretary to Government (NAM) Code Nos 57, p125 [5] Cassar, Paul. Medical History of Malta (London & Beccles: William Clowes & Sons Ltd, 1965), 61 [6] Nursing: Historical, Present and Future Perspectives; History of Nursing in Australia available on: https://nursekey.com/nursinghistorical-present-and-future-perspectives/ [7] Hemani Hafiza (1996) The History of Nursing in Pakistan: A Struggle for Professional Recognition. Unpublished Master’s dissertation, University of Alberta available on: https://era.library.ualberta.ca/items/fde89382-3ac3-4914-b0efab0dbfd52e09/view/18d2541a-df1e-4a37-8871-d980d26cbe15/MM18352.pdf [8] Register of References to the Comptroller of Charitable Institutions (NAM) Code No 8, pp73-75 [9] Register of References to the Comptroller of Charitable Institutions (NAM) Code No 11, p 27 [10] Julyan, Penrose G. Report on the Civil Establishments of Malta (London: 1880) p26 [11] Register of References to the Comptroller of Charitable Institutions (NAM) Code No 8 – 52 [12] Galizia, J.S. Il Ctieb tal Infermier. (Malta:1904) [13] Cassar, P. Medical History of Malta 407 [14] Register of References to the Comptroller of Charitable Institutions (NAM) Code No 32, p80 – 85, 115-119,131-136. [15] Register of References to the Comptroller of Charitable Institutions (NAM) Code No 49, p167. [16] Malta Government Gazette (MGG) 29.10.1915, No. 5762 p636 [17] Cassar, P. Medical History of Malta p 407. [18] Cassar, P. Medical History of Malta p 403. [19] John Manduca, The Bonham-Carter Diaries (1936-1940), (Malta: Manduca; 2004), 220. [20] Hemani H. (1996) The History of Nursing in Pakistan: A Struggle for Professional Recognition [21] Charles Savona Ventura, Contemporary Medicine in Malta (1798-1979). (Malta: Publishers Enterprises Group (PEG); 2005), 331. [22] Solano Diana & Rafferty, Anne Marie. Can lessons be learned from history? The origins of the British imperial nurse labour market: A discussion paper. International Journal of Nursing Studies Vol 44 (6) (2007) p1058 [23] Nursing in the Carribbean maps/nursing-caribbean available on: https://www.encyclopedia.com/history/encyclopedias-almanacs-transcripts-and- [24] Hemani H. (1996) The History of Nursing in Pakistan: A Struggle for Professional Recognition Bibliography // [50] Croatian Nurses Association – Backbone of nursing professionalization in Croatia Sanda Franković1, Damjan Abou Aldan2, Tanja Lupieri3 1 Nursing school Mlinarska, Mlinarska 34, Zagreb, Croatia; 2High school Koprivnica, Trg slobode 7, Koprivnica, Croatia; 3quot;Sveti Duh" Clinical Hospital, Sveti Duh 64, Zagreb, Croatia Introduction. From a historical perspective a professional association is one of the elemental bedrocks of development of a profession. Croatian nurses association (CNA) did not have its history completely depicted. Because of this it was not possible to do a wholesome review of its part in professionalization of nursing in our country or its contribution to development of nursing in countries with which Croatia once shared its borders. Methods. Starting points for this article were sources in Croatian State Archives, State Archives in Zagreb, archives of CNA, journals published by the association, documentation stored in private property and papers published on this topic so far. Results. In Croatia, we are unaware of any significant efforts in the study of the nursing history. Historical material that should be the backbone of this effort is unknown (although some have partially been detected in the archives for the purpose of writing reviews on topics that are not related directly to nursing) or is scattered in private possession or destroyed by negligence. As a result, to this day only few areas have been systematically processed: history of institutions that educate nurses through occasional monographs like Lujza Janović Wagners biography; nursing journals Nursing word, and socio-medical work of nurses between the two world wars. Additional aggravating circumstances were the two devastations of Croatian Nursing Association premises where parts of the archive were stored, adding to the problem of finding permanent accommodation for the Association. During the 1970s a flooding occurred in the basement of School for Nurses Mlinarska where the membership files and some archive material were stored. On this occasion almost all of the material was destroyed. The destruction of the documentation also happened in 2004 when the lack of maintenance to installations in Mlinarska School from 1923 led to fire which partially destroyed archive material. Systematically gathering and storing of archive material of the CNA started in 2013 with the establishment of the CNAs Association for the History of Nursing. The establishment of the School for Nursing in Zagreb marked the beginning of the professionalization of nursing in Croatia. The school was founded in 1921 with a statement that the School was established with the aim of educating professional staff for the dispensary service. With the creation and development of the profession, there was a need for nurses to be organized into a professional association so that they could more easily and credibly represent and promote their status, ideas and needs. For now, no document is available to testify to the exact date of the founding of the Graduate Organization of the Nurses of the School for Nurses in Zagreb, as the first professional association, but it can be inferred from the two available texts that the nurses began the debate on the establishment of their professional organization between 1927 and 1928. Changing the name of the state, the Graduate Nursing Organization of the School of Nursing in Zagreb changed its name and partnered with existing associations in Ljubljana and Belgrade to qualify for membership of the International Council of Nursing. It appears that the first name of the newly established association for the territory of the Kingdom of Yugoslavia was the Yugoslav Union of Nursing Associations formed in Zagreb on June 6, 1929. The Yugoslav Union of Nurses likely changed its name and organizational structure at the first congress held in Belgrade in 1930. The assumption is that a general meeting was also held at that time. Records from that assembly are not available, and the reorganization and change of name to the Yugoslav Association of Graduate Nurses. In December 1932, the Zagreb Nurses published the first magazine in the territory of the former state called the Journal of the Savska Banovina Section of the Yugoslav Association of Graduate Nurses. Probably only one issue of Journal was published, after which in January 1933 the magazine Nursing word began publishing. At the annual assembly in Ljubljana, it was probably agreed to change the name of the magazine to become the official newsletter of the Yugoslav association. The Nursing word was printed at the printing house of the School of Public Health in Zagreb. The editor was Lujza Janović Wagner. Her dedicated work and exceptional talent have shaped a professional journal that contains the most significant issues of nursing work of the period and valuable reports on the work of the Yugoslav association and its sections. In 1939. Croatian Banovina was created as a part of Kingdom of Yugoslavia and in August of 1940 Croatian nurses founded an independent Graduated Nurses Association of Croatian Banonvina. Shortly after, Second World War began but despite the war condition the Association did not stop with its work or stopped publishing its journal. Found documents from that period suggest that current government did not look favourably on work done by the association. After the war Croatia changed its name on several occasions and following that so did the association. End of the war found nurses decimated by war troubles and a lot of effort had to be put into gathering them and restarting the work in Assotiation. Associationʹs archive materials for the period between 1945. and 1954. is not located for now but accordind to few information that are available it can be assumed that the Association kept working in that period. In 1953. Association changed its name to Graduated Nurses Association of People's Republic of Croatia. [51] Again in 1954 different associations in Yugoslavia gathered into Union of Yugoslavian Nursing Associations so they could renew their ICN membership. Croatian nurses restarted nursing journal that would become official publication of Union of Yugoslavian Nursing Associations. For the whole time it was published, journal was edited in Zagreb. In 1962, the Association changed its name to Nurses Association of Socialist Republic of Croatia. Croatian nurses started their own journal. Pneumophtisiology section and Section for Primary Health Care also published their own journals but unfortunately, they were published for only 15 years. After Croatia became independent Association changed its name to Croatian Nurses Association and continued to publish its journal. Association started the initiative to create Nursing union and chamber. It will also be an active partner in efforts to start a university level of nursing education. We managed to conclude based on the collected data, changes in association’s names during the last ninety years, its publishing work and topics that were the primary point of focus in a certain period. Information concerning association’s presidents and members of its governing bodies were partly discovered. From discovered records we can conclude that Croatian nurses association, a successor of a nursing association that was by the available data most likely founded in 1927., represents a backbone of nursing professionalization in Croatia. Its efforts are evident in activities that are directed towards publishing professional journals, codes of ethics, efforts to define nursing competencies, organization of continuous education, keeping track of nurses, protection of nursing uniform, advocacy of nursing education on a university level, founding of nursing syndicate and chamber. Collaboration with ICN and other specialized nursing associations. Developing a network of cooperation with branches of Croatian Nursing Association. Based on the collected data we reconstructed changes in association’s names during the last ninety years, its publishing and topics that were the primary point of focus in a certain period. Information concerning association’s presidents and members of its governing bodies were partly discovered. Conclusion. Croatian nurses association, a successor of a nursing association that was by the available data most likely founded in 1927., represents a backbone of nursing professionalization in Croatia. Its efforts are evident in activities that are directed towards publishing professional journals, codes of ethics, efforts to define nursing competencies, organization of continuous education, keeping track of nurses, protection of nursing uniform, advocacy of nursing education on a university level, founding of nursing syndicate and chamber. References Franković S, Kralj Z, Glavaš T, Jurinec B.History of Croatia nursing – undiscovered territory. Sestrinski glasnik (Nursing journal). 2018; 23: 99-103. Dugac Ž. O sestrama, siromašnima i bolesnima – Slike socijalne i zdravstvene povijesti međuratnog Zagreba (About nurses, poor and sick – Images of social and health history od Zagreb between two World wars). Zagreb: Srednja Europa; 2015. Grković Janović S. Sestra Lujza (Nurse Lujza). Split: Naklada Bošković; 2003. Grković Janović S. Sestrinska riječ – između sućuti i dužnosti (Nursing word – between compassion and duty). Zagreb: Medicinska naklada; 2015. Bibliography 1. 2. 3. Hofgräff, D. i Franković, S. (2017). Osnutak škole za sestre pomoćnice u Zagrebu 1921.–1922.(Foundation of the School of Nursing in Zagreb 1921–1922). Arhivski vjesnik, 60 (1). Franković S, Kralj Z, Glavaš T, Jurinec B.History of Croatia nursing – undiscovered territory. Sestrinski glasnik (Nursing journal). 2018; 23: 99-103. Franković, S. i Hrga, I. (2019). Značke medicinskih sestara u Republici Hrvatskoj između dva svjetska rata: koja je bila prva? (Nurses’ badges in the Republic of Croatia between the two world wars: which was the first one?). Sestrinski glasnik, 24 (3), 151-155. [52] New Perspectives on Christiane Reimann (1888-1979): Life and work of the Lady behind ICNs “Nobel Prize” in Nursing Susanne Malchau Dietz Danish Nurses Organization (DNO), Denmark This paper addresses Danish Christiane Reimann (1888-1979) who was Executive Secretary of the International Council of Nurses (ICN) 1925-1934. Reimann is well known for her contribution to international nursing and her significance to ICN’s progress and development. She initiated and created many key ICN programmes including ICN’s official journal. Reimann retired in 1934 to take residence in Sicily, Italy. By her death she donated the so-called ‘Nobel Prize in nursing’, named the Christiane Reimann Prize. Since 1985 significant nurses has been awarded at the ICN conferences. The first was Virginia Henderson. The life and work of Reimann is due to few primary sources only superficially documented in the ICN publications and a few short biographies. However recently an unknown private Reimann archive is discovered in Syracuse, Sicilia, Italy. This makes it possible to re-write the Reimann biography and include much more about her contribution to international nursing. The study (in progress) is methodologically based on the life-work biography and themes to be presented is e.g.: 1) Reimanns education at Teachers College, NY where nurses as Isabel Stewart and Lillian Wald became her role models, 2) the fact that she introduced nursing history at ICNs conferences and was asked to author a 5th Vol. of Nutting and Docks A History of Nursing, 3) her compassion for statistics and claim to be the first after Florence Nightingale to develop an international tool to calculate ‘a ratio of nurses to patients’. In the late 1920s she conducted an investigation involving 40 countries and by that gave a massive picture of nurses’ working conditions internationally. The nursing community welcomed it. This masterpiece of research also became Reimanns “Waterloo” as it was in this context she met German Dr Alter who made her resign from the ICN just to betray her in the cruellest way. Bibliography // [53] Sovereignty and charity: the case of nursing and hospitals in Ethiopia in the mid twentieth century Sioban Nelson University of Toronto, Canada In 1955 the government of Ethiopia marked the 20th anniversary of the establishment of the Ethiopian Red Cross by the issue of three stamps featuring Princess Tsahai, the eldest daughter of Haile Selassie, at the bedside. The princess, who had been founding head of the Ethiopian Red Cross in 1935, undertook nursing training in London during the Selassie exile. She returned home in 1941 with a mission to establish a model hospital for nursing and medical education, but tragically died in 1942 from complications of childbirth. This paper looks at the realization of this vision through the establishment of the Princess Tsahai Memorial Hospital in Addis Ababa in 1949 through a philanthropic campaign initiated and led by veteran suffragette and pro-Ethiopia advocate Sylvia Pankhurst through the Princess Tsahai Memorial Hospital Fund based in London. The language of freedom and African independence articulated by the Ethiopian Red Cross is juxtaposed with the philanthropical program in support of the Memorial Hospital which engages the highest levels of the British establishment. Taking a material culture perspective and using archival sources from Sylvia Pankhurst’s papers, as well as missionary and newspaper sources, I examine the role of foreign powers and missionary groups in the establishment of health care and nursing training following the Italian occupation. I argue that the Ethiopian case provides an early example of the geopolitics of the post-war period of African decolonization, where foreign powers competed for influence through healthcare aid. An examination of three sets of stamps issued to honour the Ethiopian Red Cross in 1935, 1955, and 1975 respectively, offers insight into the highly political and evolving nature of government’s portrayal of Ethiopian nursing and the role women in the health of the nation. I argue that issues of colonialism, gender and African identity are played out through the story of nursing education in postwar Ethiopia. Bibliography // [54] Nursing in Tarapacá: visible and invisible Lidia Elena Osorio-Olivares, Sonia del Carmen Cruz-Cisternas, Cecilia Moya-Suarez Red Historia Enfermería Chile, Chile Tarapacá region is located in the extreme north of Chile, within the driest desert in the world. Its immensity, the landscapes, the inhabitants, its history, but particularly its nursing’s history has encouraged us to come true a lifelong and cherished dream: to rescue its history. Nursing’s history in Tarapacá is full of achievements and yet it remains invisible. Showing our work’s progress in the same place where Florence Nightingale was born is certainly an honor and, at the same time, a tribute to the pioneers of nursing in Tarapacá region. Tarapacá was a Peruvian territory until 1879; from then on it belongs to Chile. Its demographic growth can be linked to economic cycles derived from the exploitation of guano, saltpeter, and copper. Migrations from the world and inside the country originated to its population which coexists with its ancestral inhabitants: Aymara’s and Quechua’s peoples. These people mainly inhabit the highlands, maintaining its culture and customs. The distances are considerable; the weather dramatically changes from high temperatures during the day to below zero at night. Besides, many social movements were born in this territory. This is the context where nursing in Tarapacá region was developed. Nursing professional training in Chile began in 1906, though the first professional nurses only arrived in Iquique in the fifties. We have hold interviews with the first nurses, examined documents, read history and shared the excitement of our work with colleagues, students, and people who are interested. This issue has aroused a great interest in all of them. Iquique went from being a small town to become a cosmopolitan city with great demographic growth. This situation implied that the needs had changed and implementing health care was the one that arose among others. This was particularly relevant for the region since it had been continually devastated by the outbreak of plagues as well as massive earthquakes. Due to the lack of good health care, implementing a hospital was a need to meet. From the beginning and for many years the care of sick people had been in charge of religious people and auxiliary personnel called "practitioners." Therefore, there were many changes in health care system when professional nurses arrived in this region; young, trained and eager professionals reorganized the health care system. During those years the country lived a period of changes. The main cause of concern was the poor living conditions of the great majority of the population. While the social movements demanded improvements, the rulers and politicians passed laws that would allow improving this situation. Nurses were becoming consolidated professionals. Apart from working hard so as to improve health care, they also understood the need to train themselves to best face the challenges that were presented. This is why several nurses received both international and national training. Chile was able to implement new health policies. During that decade nursing was not only an established professional training, but it also allowed access to formation. Moreover, it had an organized nursing structure which permitted coordinating its work in a very long country with unique situations. In Tarapacá region, nurses soon realized that there was a need to improve the population's access to health care. It was no longer possible to wait for people to arrive sick at the Hospital, there was a need to get closer to the communities, providing health care that allowed health promotion and prevention. This is how health care was born in geographically remote zones with different cultures and histories. An indicator that shows the health care situation in the country during those years is infant mortality, with figures that amounted to 300 annual deaths per 1,000 live births. One of our interviewees is Eliana Montenegro, a 90-year-old university nurse. She was one of the first professionals of this discipline in Iquique. She told us the beginning of her story as a student: “We signed up with my partner, we both came alone on a train trip that took us three days, it was an adventure.” It was the second decade of the twentieth century, a time in which the north of Chile was living the last stages of wealth provided by the saltpeter. Eliana studied Nursing at Valparaíso University, 1,800 kilometers away from Iquique, "It was an adventure," she said. The profession chosen was nursing. The choices of professions selected by young women were mainly those considered suitable for women, those socalled “feminized” like nursing and pedagogy. “I graduated in 1953 and then I arrived in Iquique approximately in February. I showed up at the Iquique Hospital and I was hired immediately.” Back then Iquique had a quite new hospital that had opened in 1940; it advertised a better selection of its staff which included registered nurses. The number of nurses at Iquique’s hospital was reduced. No more than five. In our training "We saw little public health, everything was hospital nursing." said Eliana. Another interviewee, Graciela Araya, moved to study to Iquique from Oficina Alianza in the 50s. “When she was studying in second or third year of secondary school a classmate, Eloísa Montenegro, showed her a picture of her elder sister (She was Eliana), who was studying nursing in Valparaíso. She was impressed with the uniform and since then the idea of studying nursing emerged.” Different generations remember that the training was very strict, demanding in formal aspects and good clinical preparation. “I came to Iquique and started working on February 1963 at the hospital in Medicine, and then I went to CAMI (Center of Maternal and Child Care). It was a challenge that I wanted to take because a teacher had told us that we were predominately clinical. He had suggested that we chose clinical fields because we were going to do it very well there. But he suggested we didn’t choose the epidemiology area, nor did we choose the offices, which at that time were health centers in development. He didn’t see us in that style, so I said that I was [56] going to try to do the opposite.” Thanks to the rebellious spirits of those who were arriving at this new experience and the vision of those who proceeded, new airs were incorporated into the attention of health care. In the country there were also changes during the 50s and 60s. These were characterized by a boost of social benefits, an improvement of the indicators of life quality of the Chilean population, and a trend for health accessibility. Roads were opened up to public health; PHC (Primarily health care) began to be discussed. Health care began in the inlands and the coast. In poor conditions it reached villages near the 4,500 meters high and fishing coves far away from the city. For the first time this community took part in a vaccination program, child health control, pregnancy control, medical and dental care, food delivery, and social orientation. There was an establishment of an important collaborative relationship with teachers and the police who were trained in health. "It was difficult" they said "we slept anywhere we could," "we didn’t understand that culture since it was so different, there was a lot of “naiveness" said Eliana, referring to the lack of anthropological preparation. The rounds lasted 2, 3 or even 5 days, the nights were cold, and there was an intense heat during the days. For the first time those villages had health care. Currently each location has a health care facility, all children are vaccinated, and pregnancies are controlled. Access to PHC is part of everybody’s life. These same nurses were the ones who managed to open health offices in the city, after observing that Iquique was growing and that people had difficulties to reach the hospital where everything was centralized. “We proposed to the chief doctor to open health care in towns, he told us: do whatever you want, but you have to manage because there are no resources” said Graciela, “so we got some wood from Irene's husband. He worked in construction and they were disarming railroads. Using those sticks we started to build spaces for health care’s attention.” This measure allowed us to bring health closer to the community. Infant mortality in the country is 6.4 per 1,000 live births Iquique’s inlands, the most distant populations from hospitals, today have access to health care, promotion, and prevention. The nurses who began this path such as Eliana, Graciela and many others opened the way to health care. This is something unknown that should be spread. It is an encouragement for current and future generations. Our main purpose is to continue rescuing the nursing’s history in Tarapacá. The knowledge our history is crucial. “Our past returns to the present; it is the present. We are living the past and the present together. This is the concept of Nairapacha from the Aymara people who, with their ancestral wisdom, can help us as a guide and encouragement. Tarapacá region, Iquique. Chile February 2020. Bibliography 1. Historia de la Enfermería en Chile .- Edith Rivas, Capitulo Historia enfermería en Tarapaca autoras Osorio L;Cruz S; Moya C., 2019 Universidad de la Frontera. [57] Social political role of Nursing (1971-1975): history of two chilean nurses victims of forced disappearance by the state of Chile Patricia Grau-Mascayano1, Ricardo Pérez-Abarca1, Lidia Osorio2, Celsa Parrau1, Trinidad Alcayaga1, Alejandra Palma1, Scarlett Palma1, Karla Rodriguez1 1 Universidad de Chile, Chile; 2Universidad Arturo Prat, Chile Introduction Nursing, despite being an activity always present in the history of humanity, has had evident difficulties in making itself visible and positioning itself as a discipline. The construction of collective memory is essential for the social validation of a science-profession. The political and social pattern of nursing is controversial for some authors, as is the emancipator; last of the patterns of knowledge declared after Carper, being the subject of analysis of disciplinary debates and from the History of Nursing. Objective To understand the trajectory lived by Sara Donoso and Rosa Soliz as nursing students from the U of Chile, which led them to social and political actions during the years of their formation, and which led to sanctions, arrests and subsequent disappearance at the hands of the State of Chile in 1975. Methodology Construction of historical memory through critical review of primary and secondary sources: legal documents, archives, books, in-depth interviews, timeline. The historical context was described through critical analysis, the results obtained were conceptualized and interpreted, making causal and disciplinary inferences. Approved by the Ethics Committee of the Faculty of Medicine University of Chile. Results Seven in-depth interviews were conducted with family members, fellow students, political parties and professors from the Faculty of Medicine, in addition to the review of documentary sources. The information was analyzed under the emerging categories: biographical trajectory; nursing training context; care and significance. Biographical Background: Sara Donoso Palacios, was born on February 11, 1950 in Antofagasta. Her father works at the Pedro de Valdivia Saltpeter Plant. In 1953, at 3 years old, the family migrated to Santiago. She´s studying Basic and Secondary Education in Public Schools. She entered Nursing in 1971; actively participated in student work, volunteer work, and activist in Juventudes Socialistas Rosa Soliz Poveda was born in Nuhuentue on July 27, 1950, her family migrated to Lota, a mining town. She studies at the Caleta Blanco School, she is the oldest of 7 siblings, she lives Lota's long strike with her family and the Valdivia earthquake. His family moved to Santiago in 1963 due to Silicosis of the father. They live in a homeless camp in the Santa Monica de Recoleta sector. She begins social work, with children and young people. She studies in public high schools. In 1971 she received a scholarship from the Popular Unity government, entering to Nursing School of the University of Chile. It is linked to student social political work. They develop a close friendship with Sara. After september 11 of 1973, Sara and Rosa were summoned, their enrollment suspended. In 1975 Sara re-entered the School, makes her final practice at the Consultorio Independencia, where she was detained on July 15. Rosa is integrated to work for her support and her family. She was reportedly arrested on July 7, 1975 for state forces. During the dictatorship they were linked to tasks of the clandestine leadership of the PS and both lived together. They were last seen at Villa Grimaldi Torture Center. They are still detained and disappeared. In April 2018, the University of Chile awarded them the posthumous title of Nurse. Nursing Professional Training Since 1968, the training of professionals changed radically, deepening in the Government of Popular Unity according to the political project. One of the main objectives was to improve the health and education conditions of the entire population. Her nursing education is related to her own life trajectories, meeting a university and national context in social and political transformation. "On the first day of classes (...) the topic of health in general began to be discussed, the teacher (...) gave us the possibility of giving an opinion regarding the concept of health and there immediately began to appear criticism from each one, from those who dreamed of being nurses to care for humanity, being smiling, and collaborating with doctors and being good people, and another group that did not have much idea and another group that thought that health was a contribution to society and that it was required make transformations ”(E 4) "In 1972 (...) the environment in general very effervescent and particularly in youth, (...) one entered the university, (...) with the novelty of changing to the university, (...) the changes that this brings, but in addition to participating as citizens in the life of the country, it was not only training for a certain profession, but (…) being a participant in what was happening in the country. ” (E2) The training involved community and close-to-people practices: “we went through the infirmary opening our eyes to the world, we were moved by inequalities, we were motivated to fight for changes, it was not easy to comply with the three academics, the practices and at the same time actively participate But we did it! ” (E4) Care Which is also gathered by the testimony of his brothers. “(…) The job (…) was to work with youth or children within the population, my sister already did it, she helped other children who had problems with their homework, reading problems or math problems, she helped them in the house but the need to form a youth group was born from it, so she formed this youth group together with other young companions of the population, we did volunteer work within the population, we went out to clean up, pick up trash. ” (E7) Transcendence, Disappearance, Disengagement and Silence Both had a university life that not only included formal studies. The vast majority of the people interviewed who met Sara and Rosa agree on the closeness between the two: "(...) (Sara) was interested in social causes, but since we had neither political nor religious training (...) and there he met the Rose, if it was the Rose who introduced her to the party, in the political question ”(E1). After the Military Coup, their political participation became more relevant as they took the leaders of the Socialist Party prisoner. The arrest is part of an action by the DINA National Intelligence Directorate. They were brutally tortured. In [58] 2020, the whereabouts of neither are yet known. Conclusions In relation to Sara and Rosa, the question arises: How is the memory of those who have been victims of the repression and whose bodies have not been found and "duly buried" configured? Although the phenomenon of political repression is not entirely new in Chile, undoubtedly the massive torture and forced disappearance of people represents a horrible novelty, after the 1973 military coup. In the words of Ana González, leader of the Group of Disappeared Detainees of Chile, who says "The Dictatorship took away the right to Life and Death" The lives of Sara Donoso and Rosa Soliz are a representation of the importance of the proposed and emancipatory, political and social role of nursing. Motivated by deep ideological convictions, they were important members of a political party, prominent nursing students, who understood their vocation as a tool for transforming the health of individuals and communities. Political activism was permeated by the functions of care which allowed a real connection with people and communities, seeking social justice. Being women and the role of care implied that they carried it out in multiple dimensions, even knowing that they exposed their lives for their convictions, as well as the care of people who were being persecuted by the Dictatorship. Both students had a different leadership, which in turn was complementary. "Synergy of Knowledge": Popular / Intellectual. In Chile, just in the last decade, Nursing research begins to build "bridges to understand how and why this group makes the political participation of its members invisible, the militancy and resistance to dictatorial governments, as well as their disappeared" ( Morrone, 2012). Ana Velandia (2011), refers that when considering the object of historical research as "a set of interrelated processes and dependent on the evolution of society." from this perspective, no exhaustive balance of current data can replace historical knowledge (Velandia A., 2011). Lewenson and McAllister declare that it is of great interest to know the stories of nursing in other countries, because this knowledge allows us to contrast the care policies and the effects of nationalism, colonialism and wars. And finally, the relevance of this study lies in the fact that it constitutes an act of reparation in matters of Human Rights for these two disappeared nurses who received their posthumous title in 2018., from the hands of the Rector of the U. of Chile and their families. Finally, as one of the interviewees said, "Our fellow detained disappeared Sara and Rosa wanted to bury, they did not realize that they were seeds". Bibliography 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. Amezcua, Manuel. (2009). Foucault y las enfermeras: pulsando el poder en lo cotidiano. Index de Enfermería, 18(2), 77-79. Recuperado en 04 de julio de 2018, de http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S113212962009000200001&lng=es&tlng=es Arratia, A. (2005) Investigación y Documentación histórica en Enfermería. Contexto Enferm, Florianópolis. Recuperado de http://www.scielo.br/pdf/tce/v14n4/a14v14n4.pdf. Garcés Durán, M. (2002) Recreando el pasado: Guía metodológica para la memoria y la historia local. Santiago, Chile. Ed. ECO Educación y comunicaciones. Exequiel Emanuel (2003) Qué hace que la investigación clínica sea ética? Siete requisitos éticos en Lolas F.& Quezada A., Pautas éticas de investigación en sujetos humanos: nuevas perspectivas pag 84-97 recuperado de http://www.libros.uchile.cl/files/presses/1/monographs/258/submission/proof/files/assets/basic-html/toc.html Medina J., (2017) Un apunte histórico de la subordinación de la mujer enfermera en el sistema de salud. En Medina J. La pedagogía del cuidado: saberes y prácticas en la formación profesional de enfermería. (1ª. Ed 135-136). Santiago de Chile. Editorial Universitaria. Molina Bustos C. (2010) El gobierno de la unidad popular. En Molina Bustos. Institucionalidad Sanitaria chilena 1889-1989. (Primera edición 161-167). Santiago, Chile. Editorial LOM Molina Bustos C. (2010) El período de la dictadura militar 1973-1989. En Molina Bustos. Institucionalidad Sanitaria chilena 1889-1989. (1ª edición 173-181). Santiago, Chile. Editorial LOM Morrone B., (2013). Introducción. En Morrone B. Al Servicio de las ideas: La enfermería en los procesos populares de Liberación en Iberoamérica. (2ª ed. 15-25) Mar del Plata, Argentina. Editorial Suárez. Osorio Castaño, J. (2016). Patrón de conocimiento socio-político en enfermería: reflexiones conceptuales. Revista Cuidarte, 7(2), 1352-7. doi:https://doi.org/10.15649/cuidarte.v7i2.319 Siles González, José. (2004). La construcción social de la Historia de la Enfermería. Index de Enfermería, 13(47), 07-10. Recuperado en 04 de julio de 2018, de http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S113212962004000300001&lng=es&tlng=es. Siles Gonzalez, J. (2010). Historia cultural de enfermería: reflexión epistemológica y metodológica. Avances en Enfermería, 28(E), 120-128. Recuperado de https://revistas.unal.edu.co/index.php/avenferm/article/view/21456/22450 Siles J., (2013) Prólogo. En Morrone B. Al Servicio de las ideas: La enfermería en los procesos populares de Liberación en Iberoamérica. (2ª ed. 7-11) Mar del Plata, Argentina. Editorial Suárez. Velandia Mora, A.L. (2011). Fundamentos teóricos metodológicos de investigación en historia de la enfermería. Revista Cultura de los Cuidados, 3er Cuatrimestre, Año XV, N°31. Recuperado de https://rua.ua.es/dspace/bitstream/10045/20578/1/CC_31_15.pdf [59] Sister Jules-Marie Heymans (1897-1986), The ‘Belgian Florence Nightingale’ Luc De Munck KU Leuven (Catholic University Leuven, Belgium), Belgium. For centuries nursing in Belgium was the monopoly of nuns. This changed in the beginning of the twentieth century, when the first schools for secularised nurses were founded in Brussels and Antwerp. Nevertheless, the role of religious nurses remained important when the real start of a Belgian nursing tradition was launched immediately after the First World War. A religious nurse and doctor played an important role in the postwar period: sister Jules-Marie Heymans of the Sisters of Charity in Ghent. This article highlights her leadership and significance in Belgian nursing. NURSE, DOCTOR AND DIRECTOR Sister Jules-Marie was born as Maria Bertha Augusta Heymans in Ghent in 1897, as the daughter of doctor and professor JeanFrançois Heymans. Already as a young girl, it had been her wish to enter the congregation of the Sisters of Charity, founded in Belgium in 1803. When in 1908 the Belgian government created a certificate for nurses, the Sisters of Charity started immediately with a nursing course in Ghent. It was there that Maria received in 1917 her nursing certificate, after a year’s mainly theoretical training. In 1918 Heymans, who hadn’t entered in the congregation yet, started her studies to become a doctor at the university of Ghent. She was obliged to follow first two preparatory years in natural sciences. In 1920 she started her studies in medecine, and in 1922 she received her candidate’s - now bachelor’s - degree in medecine. But then she interrupted her studies, to enter the congregation of the Sisters of Charity. Her father was opposed to it. Finally, he agreed, but on condition that she might continue her studies after her profession. She indeed received a special permission of the superior general of the congregation and of the archbischop of Ghent to continue her studies in medecine. But the pluralistic university of Ghent wasn’t acceptable for the sisters, so she went in 1923 to the Catholic University of Leuven. Three year later and always graduated magna cum laude, she received her diploma of doctor of medicine, as one of the first female doctors graduated in Leuven. In 1929 she became the first director of the Saint-Vincentius hospital in Ghent, created by her congregation. She was also appointed director of the nursing school, attached to this hospital. The consequence of this double nomination was that sister Jules-Marie never had the opportunity to practice nursing nor medicine. The congregation decided that she had to fulfil managerial and not practical tasks, so she had no choice. She stayed at the head of the hospital and the nursing school in Ghent until 1939. SECRETARY OF THE FEDERATION OF CARE INSTITUTIONS A year before, in 1938, sister Jules-Marie became co-founder and secretary of the Federation of Care Institutions, created by the Belgian episcopate to represent and defend the catholic care institutions. As secretary of this federation, one of sister Jules-Maries’ first priorities was the preparation of catholic organisations for the forthcoming war. Besides these war preparations, the federation was also concerned about the important shortcomings in the catholic medical and nursing institutions. The lack of sufficient nursing personnel was one of the points emphasized by the federation, which advocated a better education for nurses. Sister Jules-Marie was the ‘heart and soul’ of the organisation, and took an active part in nearly all organisations which were active in the medical and nursing world. She fulfilled this post until 1966. DIRECTOR OF THE FIRST SCHOOL FOR ‘INFIRMIERES-MONITRICES’ In the meantime the Sisters of Charity had taken control over the nursing school in Leuven, which had started already in 1922. In 1939 the Sisters of Charity started in Leuven with a second nursing school: the first Belgian nursing school for ‘infirmières-mônitrices’. Sister Jules-Marie was transferred by her congregation from Ghent to Leuven, and became the first director of this school, a task she fulfilled until the reorganisation of the school in 1965. The two main objectives of her school were the formation of future teachers for the existing catholic nursing schools and the education of responsible nursing personnel in catholic hospitals. Students were only allowed when they had finished their three year-training as a nurse and also had experience of at least two years in nursing work. This was a completely new idea, not only in Belgium but also in Western Europe, and corresponded to the need for very well educated executive nursing personnel. The school was closely linked with the university: the rector became president of its administrative board and an active fellow thinker of sister Jules-Marie. She gave courses of deontology in the first and second year, and was also responsible for the didactical exercises. The school attracted immediately a rather important number of students. In the first ten years of the school, 106 nurses followed the two year-program. 75 of them were religious sisters, the other 31 were laics. In 1942 the school was recognized in category 1 by the Office of Technical Education, the highest degree in the ranking of technical schools. From 1949 on, the school could deliver officially the title of graduate in nursing to their students. Thanks to her management and leadership skills and her great work force, sister Jules-Marie developed this school as a ‘model school’, with a high academic level. In 1965 the school was integrated in the newly founded Centre for Hospital Sciences. This centre organized a real university education, where qualified nurses were allowed after a preparatory year and could become bachelor and master in nursing. Sister Jules-Marie was appointed lector at the university, and became emeritus in 1969. She died in 1986. THE AGENCY OF SISTER JULES-MARIE What was the agency of sister Jules-Marie in the development of catholic nursing in Belgium? A way to measure her influence and importance towards catholic nurses are the articles she wrote for Caritas, the bimonthly review of the Sisters of Charity, which has been [60] published since 1908. In 1935, sister Jules-Marie started in this review with ‘The corner of the nurse’, with articles on the morality and the deontology of the catholic nurse. Between 1935 and 1940, when the review was obliged to stop temporaly, due to the war circumstances, sister Jules-Marie published 16 articles. In an article, published in 1936, she talked about the moral responsability of nurses. Her discourse is centered around two main ideas. The first is that a nurse has to know her moral obligations very well. If she fulfils her work very consciously, she will be gloriously recompensed after her death by Christ. The second is that a catholic nurse must be always aware of her responsabilities towards the sick, the doctors, her colleagues and the institutions for which she is working. One year later, she stressed the necessary obedience of the catholic nurse. But this obedience must always be controlled by the Christian conscience. So if a doctor asked her something that is forbidden by her conscience, she must refuse, because obedience to moral duties is always prior to obedience to the doctor. But the real Christian obedience of the nurse is only obliged to God. In another article, published in 1939, she talks about the professional dignity of nurses. Her discourse is again strongly linked with God. The catholic nurse must be a light for her patients and the society, leading finally to God. These three examples give a good idea of the content of her articles and of the dicourse she wanted to present: the catholic nurse had a moral duty to her patients, but in the end her obedience to God and respect for the religious rules and habits received the highest priority. By frequently using and largely spreading this discourse, the agency of sister Jules-Marie towards the catholic nurses could be evaluated as very high. THE ‘BELGIAN FLORENCE NIGHTINGALE’ To evaluate the activities of sister Jules-Marie Heymans, the concept of scientific persona is very useful. In an often cited article of Lorraine Daston and Otto Sibum, published in 2003 in Science in Context, scientific persona was defined as an intermediate between individual biography and social (scientific) institution. Constructions of persona are important because they exemplify new ways of being in the world, and also form the basis for the creation of trustworthiness, reliability and predictability on social interaction. Especially in scientific communities, trust in one’s person is essential because it is impossible to rely on the other. Applied to the biography and the work of sister Jules-Marie: Belgian catholic nurses had an enormous trust and confidence in her persona, because she personalised and interiorised the nurses’ desirable attitude, the way to behave in total agreement with the catholic rules, the path to become a perfectly educated nurse. The persona of sister Jules-Marie Heymans was probably the most influential one in the history of Belgian nursing in the 20th century. Taking into account that historical comparisons are always a matter of discussion, she can without exaggeration be labelled as the ‘Belgian Florence Nightingale’. Bibliography // [61] A review of the literature of the impact of the theory of Nursing and the environment of Florence Nightingale: a neverending story Luigi Apuzzo1, Maddalena Iodice2, Francesco Burrai3 1 Sant'Anna and San Sebastiano Hospital, Caserta, Italy; 2ASL RM4, San Paolo Hospital, Civitavecchia, Italy; 3ATS Sardegna, Italy Background: Nurses can base their assistance on different nursing theories that are distinguished by definitions and relationships given to the globality of the human being and his needs, that lives health and disease in a unique way, indicating a different model of assistance during the illness considering the continuous interaction of man with the environment in which he finds himself. Florence Nightingale (1820-1910) had the intuition to apply the scientific method of statistics, focusing her theory on the environment, which represents external influences that act by preventing, healing or contributing to evolve the disease. The nurse have to put the patient in the best possible condition so that nature acts. According to Nightingale, the disease is a repair process that nature puts in place in cases of need and nursing must provide a healthy environment for the patient, to promote health and its improvement). Aim: The aim of our literature was to find the contributions of Nightingale theory concept on today’s healthcare workers and hospital care organization Methods: We conducted a database research (Cinahl, Pubmed, Cochrane), for studies published in English in the last decade. Other criteria to select the articles were considered: original research, reflections and literature reviews; fully available online; and which contained the words Florence Nightingale in their titles or abstracts. Findings: We found 418 publications, 178 of which were fully available. We excluded duplicate productions and the articles that did not present adherence or relevance for our review. The final sample was composed of 9 articles. Act on the environment according to the theory of Nightingale in the care settings and hand hygiene are recognized as a fundamental step in the fight against infections, and in the holistic assistance of people. Greater awareness both in environment attention and hand hygiene professionals is needed and it is an important also as advocacy of patients. Discussion: The theory of Nightingale is still applicable and in the contexts where it is applied brings improvement in the care outcomes. The theory of Florence Nightingale is still attracting nurse in all the world. The analysis of Nightingale’s theory is judged on the base of set criteria including Significance, Internal Consistency, Parsimony, Testability, Empirical Adequacy, and Pragmatic Adequacy. Nightingale very simply and clearly describe the concept of environment and its role in disease and health continuum. She clearly describes the environment and its essential elements that are fresh air, clean water, proper sanitation, cleanness and light, and she considers illness as imbalance in these essential elements and believe that manipulation in environment makes client prone for acting of nature. Nightingale was aware of germ theory and the role of hygiene in infection control (de Almeida Medeiros, Enders and De Carvalho Lira 2015) Her quality management principles and research capabilities are to be admired. She is considered an innovator in the collection, tabulation, interpretation, and graphical display of descriptive statistics. Nightingale also developed a Model Hospital Statistical Form to enable hospitals to systematically collect and generate consistent data and statistics, again impacting on quality management. As Nightingale demonstrated, statistics provided an organized way of learning and have the potential to lead to improvements in health and surgical practices. Florence Nightingale facilitated practice change through presentation of data. (Kralik 2010) The application of the theory is possible in every setting, even the poorest and where there aren’t resources (Kalua, 2015). The Nightingale's theory has been used in nursing education and patient care in different clinical settings by nurses around the world (Awalkhan, 2016). The theory is applicable for the improvement of hand hygiene and infection control (Mitchell, 2017; Quilad, 2019), in the improvement of control of spread of infectious disease (Kamau et al, 2015) in the management of medical disease and surgery disease (Awalkhan, 2016) The holistic vision of the nurse assistance of Nightingale was used to improve the outcome of the assisted people (Attewell, 2010). Environmental health is studied both in hospital setting and in home setting, to help patients and their caregivers. The variables studied based on Nightingale's environmental theory aim to explore what affects the quality of patient care and patient safety. The data also revealed that nurses are aware of the role of the designed environment plays into patient outcomes, and while the exact aspects of the design environment may not yet be completely isolated, they are exploring research questions with this in mind. It is also interesting to note that some of the significant results in line with the attributes of Nightingale's environmental theory. Sound and noise have been classified among dependent variables and sleep among independent variables (the result of sound and noise). The use of multiple or mixed methods for studying Health research questions are supported. Bedside nurses are best placed to, through observation and research, understand how the design environment affects their patient during the act of nursing (Zborowsky, 2014). It exist a different perception of Nightingale environmental theory, such as environmental health assessment, environmental health education, environmental exposures (Polivka, 2018). Nurse practitioners/researchers received contributions from the Nightingale theory to explore these topics and publish the results in nursing journals to share and increase environmental care. Nurse world-wide must be encouraged and supported in empirically addressing environmental theory and promoting healthy and safe environments. Florence Nightingale Theory and Current Day Health Care System: Contradictions A century has passed since the issuing of her theory, it seems obvious that some of the concepts contained therein are in contradiction with current regulations. [63] For example, to become a nurse, today an academic qualification is needed, without the obligation or involvement of religious beliefs. This aspect has completely replaced the concept of vocation and self-sacrifice in honor of the profession and the patient, in virtue of God's call. Furthermore, another aspect of the Nightingale theory that is difficult to apply is the night rest of the person who must never be disturbed, and that at night there is a need for an environment as quiet as possible. Instead we are aware that with today's technological equipment it is not always possible to guarantee silence in hospital wards and the need to administer medications or the detection of vital parameters even during the night, often disturbing the person's rest (Awalkhan, 2016) Other authors criticize her administrative position and dedication to recording her results rather than engaging in direct assistance (Frello & Carraro, 2013). Implications for future research Research is focused on her biography and her written work is used as a theoretical and methodological framework for nursing studies in the world, including Italy, where surely Nightingale’s theory has led Italian nurses to a greater interest in research and statistics, for the care of the environments, for a greater sense of ethics in patient care, and evidence based best practice. Educate, encourage and provide funding to nurses who are the professionals who can best conduct research by being mostly with patients in the ward, being careful to evaluate the populations most vulnerable to environmental impact (intensive care units, children, the elderly). Support the replication of studies and disseminate the results in order to guide future practice and research. Implications for practice We found several recommendations for Nursing in the 21st century based on Nightingale’s theory, which were adapted to the present days such as to promote health and influence with positive examples and to use interdisciplinary and intercultural collaboration to promote community health; with a global mindset and local action to create health education to everyone; support an holistic health. Also, it is important to educate nurses and other health workers and whoever they are involved with in providing assistance in a healthcare context, on the importance of the impact of the environment on the assistance provided. Conclusion Nightingale created the basis of the public health nurse and her philosophical thinking laid the foundations of modern nursing care by transforming the vision of health care. She was innovative, influencing vast areas of knowledge. The testability criteria of a ground nursing theory such as her has assessed that the research methodology is congruent with the content and the philosophical position of the theory and the data collection methodology has satisfied the essence of ground theory. Her contribution in the various areas of nursing (direct assistance, research, leadership) was immeasurable. After 200 years, it is still inspiration for students and experienced nurses, who analyze her theory, all over the world. It is still possible to apply her theory, adapting it to the present day. The theory is defined in detail, and the abstract concepts of the theory are best represented by its creator, just as the concepts of spirituality and integrity are well explained in her theory and are applicable in patient care approaches. The main concepts of the Florence theory (noise, spirituality and the environment) are verifiable hypotheses and, combined with Nightingale's work on the importance of statistical analysis, they guide the nursing professionals of the present century. This review helps to increase knowledge about Florence Nightingale, the woman who turned nursing into a science. Bibliography 1. 2. Attewell, A. (2010). Florence Nightingale’s relevance to nurses. Journal of Holistic Nursing, 28(1), 101-106. Awalkhan, A., & Muhammad, D. (2016). Application of Nightingale Nursing Theory to the Care of Patient with Colostomy. European Journal of Clinical and Biomedical Sciences, 2(6), 97-101. 3. Beck, D. M. (2010a). Expanding our Nightingale horizon: seven recommendations for 21st-century nursing practice. Journal of Holistic Nursing, 28(4), 317-326. 4. Beck, D. M. (2010b). Remembering Florence Nightingale’s Panorama: 21st-Century Nursing—At a Critical Crossroads. Journal of Holistic Nursing, 28(4), 291-301. 5. Frello, A. T., & Carraro, T. E. (2013). Florence Nightingale’s contributions: an integrative review of the literature. Esc Anna Nery Rev Enferm, 17(3), 573-9. 6. Harper, D. C., Davey, K. S., & Fordham, P. N. (2014). Leadership lessons in global nursing and health from The Nightingale Letter Collection at the University of Alabama at Birmingham. Journal of Holistic Nursing, 32(1), 44-53. 7. Kamau, S. M. (2015). Applying Florence Nightingale’s Model of Nursing and the Environment on Multiple Drug Resistant Tuberculosis Infected Patients in the Kenyan Setting. Open Access Library Journal, 2(08), 1. 8. Kralik, D. (2010). Celebrating 100 years: reflections on Florence Nightingale’s contributions to quality nursing care. J Adv Nurs, 2010 Aug;66(8):1657. 9. McDonald, L. (2010). Florence Nightingale: passionate statistician. Journal of Holistic Nursing, 28(1), 92-98. 10. Medeiros, A. B. A., Enders, B. C., & Lira, A. L. B. C. (2015). The Florence Nightingale’s Environmental Theory: a critical analysis. Esc Anna Nery Rev Enferm, 19(3), 518-24. 11. Mitchell, A., Boisvert, E., Wilson, T., & Hogan, S. (2017). Hand Hygiene-A Quality Improvement Project. Biomedical Journal of Scientific & Technical Research, 1(7), 1985-1988. 12. Neils, P. E. (2010). The influence of Nightingale rounding by the liaison nurse on surgical patient families with attention to differing cultural needs. Journal of Holistic Nursing, 28(4), 235-243. [64] 13. Polivka, B. J., & Chaudry, R. V. (2018). A scoping review of environmental health nursing research. Public Health Nursing, 35(1), 10-17. 14. Quilab MT, Johnson S, Schadt C, et al. (2019) The effect of education on improving hand hygiene compliance among healthcare workers. Hos Pal Med Int Jnl, 3(2), 66‒71. 15. Roque, A. T. F., & Carraro, T. E. (2015). Perceptions about the hospital environment from the perspective of high-risk puerperal women based on Florence Nightingale's theory. Revista gaucha de enfermagem, 36(4), 63-69. 16. Ruffin, P. T. (2011). A history of massage in nurse training school curricula (1860-1945). Journal of Holistic Nursing, 29(1), 61-67. 17. Selanders, L. C. (2010). The power of environmental adaptation: Florence Nightingale’s original theory for nursing practice. Journal of Holistic Nursing, 28(1), 81-88. 18. Smith, M. C., & Parker, M. E. (2015). Nursing theories and nursing practice. FA Davis. 19. Stanley, D., & Sherratt, A. (2010). Lamp light on leadership: clinical leadership and Florence Nightingale. Journal of Nursing Management, 18(2), 115-121. 20. Yamaguchi, S. (2004). Nursing culture of an operating theater in Italy. Nursing & health sciences, 6(4), 261-269. 21. Zborowsky, T. (2014). The legacy of Florence Nightingale's environmental theory: Nursing research focusing on the impact of healthcare environments. HERD: Health Environments Research & Design Journal, 7(4), 19-34. [65] Florence Nightingale, Nursing and Health Care: The Worldwide Legacy Lynn McDonald University of Guelph, Canada Nightingale did not only found the first nurse training school in the world, she established the modern profession as a profession, that is, as paid work, for which training was required, open to applicants of any faith or none at all. Up until then, “nursing” was performed by untrained people largely in the home, or untrained and disreputable women in British hospitals, or by dedicated and respectable nuns in countries with Roman Catholic religious orders. The originality of her school and her secular approach is often not understood. Nightingale’s own faith was key to her choice of nursing, but the profession must be open to persons of any faith or none at all. This paper examines the sources that influenced Florence Nightingale in writing Notes on Nursing, and then guided her later writing: the high death rates of the Crimean War (1854-56) that must never occur again. This, arguably, is an early instance of evidence-based nursing and health care. The evolution of Nightingale’s ideas is shown in the advances evident in her writing of the 1880s (in Quain’s Dictionary of Medicine), her 1893 paper to a world congress in Chicago and her advice on cholera prevention, also in 1893. Note is made of the similarity between Nightingale’s holistic definition of nursing, in her late papers, NOT Notes on Nursing), with that set out by the World Health Organization on its inception in 1948: Nightingale’s: Nursing is not only to be well, but to be able to use well every power we have to use. WHO: Health is a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity. The Nightingale School, though not the largest nurse training school, did by far the most to plant the new standards of nursing and training, not only in the United Kingdom, but in Europe, the United States and Australia. As well, Nightingale mentored key nursing leaders from other countries who came to see her in London. The table below lists hospitals to which the Nightingale School sent a matron between 1861 and 1899. England: general hospitals: St Thomas’ Hospital, Westminster Hospital, Stafford Infirmary, Bradford Infirmary, Brighton Infirmary, Royal Northern Hospital, Berkshire, Blackburn (Royal) Infirmary, Hampshire County Hospital, Gloucester Royal Infirmary, Kent and Canterbury, Nottingham, St Mary’s Paddington, York County Hospital, Northampton Infirmary, Wolverhampton Infirmary, Queen’s Hospital, Birmingham, St Bartholomew’s Hospital, Manchester Southern Infirmary, Newcastle-upon-Tyne Infirmary, Radcliffe Infirmary, Addenbrooke’s Infirmary Cambridge, Newcastle General Hospital, Great Northern Hospital, Salisbury Infirmary, Ipswich Hospital, Charing Cross Hospital, Kidderminster Infirmary, Northern Hospital Liverpool, Chichester Infirmary, Queen’s Hospital Birmingham, Worcester Hospital, Cheltenham Royal Infirmary, Portsmouth Hospital, Folkestone Hospital, Devon and Exeter Hospital, Mill Road Infirmary Liverpool, Birkenhead Infirmary, St George’s Hospital, Lowestaft Hospital, Haverstock Hill Hospital, Stoke-on-Trent Infirmary, Cheshire Infirmary, Suffolk Hospital, Richmond General Hospital, Ashton-under-Lyme Infirmary, Chester General Infirmary, Coventry Hospital, Middlesex Hospital, Workhouse infirmaries: Liverpool, Hampstead, Highgate Infirmary, Birmingham Workhouse Infirmary, Bolton Workhouse Infirmary, Fulham Workhouse Infirmary, Kidderminster Workhouse Infirmary, Whitechapel Workhouse Infirmary, Holborn Workhouse Infirmary, Lewisham Workhouse Infirmary, Paddington Workhouse Infirmary, Barrow-in-Furness Workhouse Infirmary, Other Hospitals: Bradford Eye and Ear Hospital, Royal Hospital for Incurables Putney, Gordon Boys’ Home, Liverpool Infectious Diseases Darenth Asylum, Brompton Consumption Hospital, Chartham Asylum East Sussex, Brookwood Asylum, Royal Sea Bathing Hospital Margate, Rugby Sanatorium, Southend-on-Sea Sanitarium, Central Eye Hospital, Royal London Ophthalmic Hospital, Royal London Ophthalmic Hospital,, Bradford Nursing Home, Royal Orthopedic Hospital Birmingham, British Hospital for Incurables, Royal Ear Hospital Soho, Bath Eye Infirmary, Meath Home for Epileptics, Godalming, Middleton Sanatorium, York, St Agatha’s Convalescent Home Fever Hospitals: Homerton Fever Hospital, Fever Hospital Blackburn, Monsall Fever Hospital, Convalescent: Banbury Fever Hospital, City of London Fever Hospital, Fever and Isolation Hospital Wainwright, Barrington Isolation Hospital, Farnham Isolation Hospital, Middleton Sanatorium Ilkley York, Ebbow Vale Accident Hospital, St Luke’s Hospital, Fitzroy Square, Ear and Throat Hospital, Gray’s Inn Road, The Mount Auxiliary Hospital, Torquay, Children’s: Kirkdale, Children’s Hospital Shadwell, Children’s Hospital, Newcastle, Children’s Hospital, Gt. Ormond St., Hospital for Children, Chelsea, Convalescent Home for Sick Children, Bradford, Children’s Hospital, Pendlebury, Queen’s Hospital for Children, Roehampton, Women’s/Maternity: Soho Sq. Hospital for Women, New Hospital for Women and Children Euston Rd., Hospital for Women and Children, Liverpool, Hospital for Women, Waterloo Rd., Women’s Hospital Bristol, Lying-in Hospital Manchester, Garrison Hospital for Women Weston, Hospital for Women and Children, Leeds Military: Royal Victoria Hospital (Netley), Naval Hospital Haslar, Hospital for Paralyzed Soldiers Nottingham, Empress Eugénie’s Hospital for Officers.Farnborough Lock Hospitals: Soho, Magdalene Hospital, Liverpool Cottage Hospitals: Broad Oaks, Hatfield,, Darlington, Dawlish, Cray Valley, Luton, Lancashire, North Wales, Butterfield, Upper Norwood, Warminster, Wallingford, St Albans Thames Ditton, Wallingford, Grantham, Moreton Scotland: Edinburgh Royal Infirmary, Glasgow Royal Infirmary, Aberdeen Royal Infirmary, City Hospital Aberdeen, Inverness Infirmary, Western Infirmary, Glasgow, St Andrew’s Hospital, Fife, Auchter House Sanatorium, Dundee, Gartloch Lunatic Asylum, Glasgow Wales: Cardiff Infirmary, Swansea Infirmary, Anglesey Infirmary, Cardiff Hospital, Swansea Children’s Hospital [66] Ireland: Children’s Hospital-Belfast, Dr Steevens’s Hospital, Dublin, Royal Hospital for Incurables, Dublin, Thompson Memorial Home, Convalescent Home for Children. Belfast, Belfast Lying-in Hospital, The Hospital, Belfast, Rotunda Hospital, Dublin, St Lawrence’s District Home, Dublin Canada: Montreal General Hospital United States: Blockley Hospital Philadelphia, Massachusetts General Hospital, Boston City Hospital, New England Hospital for Women and Children, Methodist Episcopal Hospital Boston, University of Maryland Hospital, Fort MacPherson Hospital. Atlanta, Salt Lake Hospital Australia: Sydney Infirmary, Gladesville Hospital for the Insane, Alfred Hospital-Melbourne, Brisbane Infirmary, Adelaide and Perth Colonial Hospital, Melbourne Hospital Europe: Uppsala University Hospital, Sabbatsbergs Hospital, Stockholm, City Hospital, Berlin, Ruffi Hospital, Nimes, Nursing Home, Rome, Surgical Hospital, Helsinki Other Countries: Mission Hospital, Kyoto, English Hospital, Buenos Aires, Eden Hospital, Calcutta, Albany Hospital, Grahamstown (South Africa), Yokohama General Hospital, Nizam’s Hospital, Hyderabad, General Hospital, Colombo, General Hospital, Calcutta, Government Hospital, St Vincent, Tomba Hospital, Cottage Hospital, St Lucia, Government Hospital, Suez, Civil Hospital Transvaal, Cottage Hospital Vryburgh Cape Colony, Gray Hospital King Williams Town, South Africa, Government Hospital, Mafeking Nightingale’s greatest achievement, it is argued, was the upgrading of the dreaded workhouse infirmaries, then the only recourse to hospital treatment for at least 80% of the population. This began in the Liverpool Workhouse Infirmary in 1865. She had hoped for legislation that would require trained nurses, which did not happen in her lifetime, but only piecemeal reforms. Nonetheless, it is argued, the opening of the National Health Service in the United Kingdom in 1948 (the first single-payer system in the world) could not have happened without the great reforms achieved gradually over many decades. She called for access to quality care for all, regardless of ability to pay, in 1866. The National Health Service Act also made health promotion and disease prevention core parts of its mandate, along with treatment, as she had held right from Notes on Nursing on. In today’s language, Nightingale was advocating universal access to health care. Bibliography 1. McDonald, Lynn (2001-12). Collected Works of Florence Nightingale. 16 vols. Waterloo ON: Wilfrid Laurier University Press. [67] Should Nurses have access to Patient Records? The Beginnings of the Nursing Documentation in Switzerland Sabine Braunschweig Bureau for Social History, Switzerland My topic concerns the cooperation between psychiatrists and nurses in the first half of the 20th century in Switzerland. My main historical source was the Swiss Journal of Psychiatric Nursing. The 19th century was a period of “therapeutical nihilism“. Only a few remedies and mechanical means were available in mental institutions. As soon as patients improved they had occupational therapy. The work was gendered. Medical innovations at the beginning of the 20th century were the prolonged bath and bed treatment. After the first World War somatic therapies were developed and introduced in mental institutions: the sleeping cure, the Cardiazole shock therapy, the Insulin shock therapy, the electroshock therapy. These therapies had great risks. Therefore, psychiatrists needed a qualified nursing staff to implement them. That is the link with the question of training. Until 1920 there was no substantial training for attendants. They learnt at work. There were often complaints about the inappropriate behaviour of the caregivers the patients before the schooling. The psychiatrists began to realize that they had to teach the nurses about psychiatric issues. One psychiatrist in Switzerland was very active in establishing a training programme for psychiatric nurses based on the model of the schools for general nursing. These Schools were already founded around 1900. The union agreed to the professionalisation of psychiatric nursing and facilitated it. So the first courses began in 1925, but there were sceptical voices on both sides. Older and long-term attendants, who usually came from the lower classes, did not find it easy to go back to school and pass an examination. And many psychiatrists feared that the attendants would get conceitedly and act like „half a doctor“. This fear of qualified nurses was a common argument for keeping them at the bottom of the hierarchy. However, the professionalisation and the medicalization of psychiatry continued and called for an improvement in the cooperation between psychiatrists and nurses. The discourse changed. The psychiatrists began to put the emphasis on cooperation. They framed their ideas of a competent staff: Nurses are „an important pillar of the doctor“, „the eye and the ear of the doctor“, „an irreplaceable mediator“. Because nurses were in constant contact with patients, they knew their behaviour, their wishes and reactions. When doctors saw the patients only for a few moments a day, they did not hear such informations. A psychiatrist wrote: „A nurse finds ways to encourage a patient to go to work. The nurse makes observations which could help the psychiatrist to find new ways for treatments. Accurate notes are needed for scientific studies. And the nurse facilitates new medical therapies.“ „Not only should the nurse get the possibility and permission to share the information with the psychiatrist, but he or she should be obliged to do so.“ he added. There was still a hierarchical working relation between doctors and nurses, but psychiatrists became aware of the usefulness of qualified psychiatric nurses. And the nurses, in turn, recognized their own growing influence on the psychiatric wards. This can be seen in many articles. A. G. for example wrote in her article „The nurse as the doctor’s assistance“ in 1929: „The psychiatric nurse carries out the medical instructions, she observes and cares for the patients and reports to the psychiatrist. And the role of the doctor – she added – is to instruct and advice the staff, not only the superiors but also the ordinary nurses, and to explain everything to them. In this way the nurses can understand what they are doing and understand the meaning of what they are doing.“ She criticized the gap between the academics and non-academics. Successful cooperations require a „distingueshed comradeship“, she stressed. Therefore, A. G. accepted the medical leadership position and respected the authority of the doctor, but demanded that also the doctor respect the nurse. The psychiatrists recognized more and more the importance of nursing observations. Such additional information could support the choice of therapies on the ward, and increase their knowledge of psychiatric illnesses. Observations and reports became a crucial issue in the newly developed nursing training. They were part of the curriculum and of the examination. Nurses had to learn to give reports not only orally but also in a written form. Several articles described how to write down the observations, sometimes in a detailed form: with ink and pen on decent paper with date and signature. It was even threatened as a dereliction of duty to omit observations or not to mention an incident if it was due to their own fault or if it was unfavourable to the patient. They should avoid unprofessional judgements and use professional expressions such as „poorly timed and locationally oriented“, „absent or dissociated in feeling“. They had to learn to distinguish between essential and insignificant observations. In Basel, for example nurses had to write a daily note in a ward book for each patient. These ward books were kept separatly from the patient files. In severe cases, these notes were copied and pasted into the patient’s file, but the books themselves must have been thrown away. The more and the better qualified the psychiatric nurses were, the stronger became the idea that they should have access to the patient files. The function and importance of the patient files were for psychiatrists an important tool for developing ideas and theories in the field of new treatments and drugs. Psychiatrists studied older patient files to learn more about a family and ancestors or about heredity and hereditary diseases. Sometimes they later inserted their findings into an old patient file. For psychiatrists, the patient records were a study they shared with professional colleagues, but: Should nurses be allowed to read the psychiatrists’ notes and add their own observations? The question was controversially discussed. Behind this debate there was the crucial question: Who was the master of the writing system? Many psychiatrists said the medical records were part of the medical confidentiality and only in exceptional cases should the nurses be allowed to read them. One doctor argued that the scientific knowledge and the technical language, the „medical jargon“, could change [69] and therefore the personal opinion of the doctor would lose value. He wanted to avoid that the nurses know about medical errors, misinterpretations and mistakes. Here too, it was the fear of a loss of authority, as was evident when the training was introduced. But the nurses wanted to know more about a patient and his history. They wanted to know whether he or she was a danger to others or to him- or herself or wether there was a danger of escape. They saw in this concealment a sign of mistrust that could harm patients and nursing staff. A qualified nurse would know about the duty of confidentiality and would not abuse it. There are not many studies on whether nurses had access to medical records in the 1930s or 40s. The historian Geneviève Heller made a research in two psychiatric hospitals in French-speaking Switzerland and found that in one hospital the nurses did not have access to the medical files. The doctors sometimes noted when they had received certain information from a nurse. This was also the case in Basel. The nurses only filled in printed forms with the nursing task such as measuring fever, temperature, pulse, etc. These pieces of paper were later added to the patient files. In the other hospital with a reform-oriented director the nurses had access and were able to fill in the patient files, but also with restrictions. Nurses should write down everything that the patient had said without commenting on it. And they were asked to write something down every day, even if nothing special had happened. The doctors, on the other hand, could write down whenever they thougt it was important. Geneviève Heller asked if this was a kind of control. The doctors decided what was important. That question of control seems plausible. At that time, psychiatric hospitals were not well regarded in public. The psychiatrists wanted to know about the work of the nurses, which was not very visible. Even though nurses’ access to patient files was limited in the first half of the 20th century, there was a regular oral exchange between doctors and nurses. Especially when young doctors had just left university, they were well advised to trust the nurses and their observations. If doctors felt too proud to accept the advice of nurses, they could get into trouble. Conclusion: The professionalization of psychiatry and psychiatric nursing in Switzerland developed in the 20th century, well after 1920 with the introduction of the somatic therapies. More than in general hospitals, psychiatrists had to take into account the experience and knowledge of nurses to treat psychiatric patients professionally. They had to accept that they needed the support of nurses, and therefore they had to teach them thoroughly. And they had to to give the nurses direct access to patients files. This happened only after the second World War following a huge medical and technological development. Bibliography 1. Braunschweig, Sabine: Zwischen Aufsicht und Betreuung. Berufsbildung und Arbeitsalltag der Psychiatriepflege am Beispiel der Basler Heil- und Pflegeanstalt Friedmatt, 1886–1960, Zürich 2013 [70] «Nursing of the alienated», 1932 - the first Portuguese manual on Psychiatric Nursing and its epochal scenario Lucília Mateus Nunes School of Health, Polytechnic Institute of Setúbal, Portugal; NURSE'IN, Nursing Unit Research for South and Islands Background The existence of a manual, more than eight decades after its publication, raises different possibilities of analysis, from the practices of use to the expressed contents - especially when it comes to work in specific field like manual written with the intention to support psychiatric nursing education. We present the manual «Nursing of the alienated» by Luís Cebola, analyze the book, author, presentation of the work, structure and contents; then the local and the national context of the psychiatric care of the time. The author José Luiz Rodrigues Cebola was born on 1876 and died on 1967. Studied at the Lisbon Medical-Surgical School from 1899 to 1906, year of defense of his inaugural thesis, The Mentality of Epileptics, developed under the guidance of Miguel Bombarda at the Hospital de Rilhafoles; in this thesis, he gathered and analyzed documents of artistic expression of epileptic patients. Worked and researched in Rilhafoles Hospital until he was appointed clinical director of the Casa de Saúde do Telhal (Telhal Health House or Telhal Asylum) on January 2, 1911, by the Provisional Government of the Portuguese Republic. Initially he would have declined the invitation, coming to accept as a service rendered to the Republic - Afonso Costa (President) thanked him for “the sacrifice, in favor of the regime” (Pereira, 2015). This analysis is consistent with the texts of Aires Gameiro, Evocation of a forgotten doctor, dr. Luís Cebola and the monograph by Aires Gameiro, Augusto Moutinho Borges, Ana Mateus Cardoso and Fernando de Oliveira, A Republican at the Convent. Was clinical director until retirement in 1949. The book - presentation Entitled «Enfermagem de alienados» («Nursing for the alienated»), identified as "Study book for the Course of the School of Nursing at the Asylum of Telhal". Note that the date of publication is 1932, prior to the official creation of the School. In the text of the presentation, we read: "Since the assistance to the alienated began to be done in the strictly scientific sense, it became necessary to instruct nurses - male and female - as they are the best collaborators of the doctor within the field of psychiatric clinic. Study book, based on my long practice of many years, that I intended for the Nursing School Course I manage at the Telhal Asylum. Since the work on the same subject has not yet appeared, I now decided to publish it, giving the exhibition a way as much as possible, clear and concise, the first part contains basic notions of anatomy, physiology, minor surgery, hygiene and pharmacy, and the second part, indispensable technical knowledge for those who provide nursing services to morbid-minded patients both in the hospital and in the Lisbon, March 1932. Luís Cebola" Two aspects are highlighted: (1) "study book, based on my long practice of many years" - which is a curious statement in a psychiatrist with a positivist background, valuing science, thus highlighting the practice; (2) "Since the work on the same subject has not yet appeared, I now decided to publish it"- should be noted that the teaching of psychiatric nursing started in Portugal in 1911, with little time difference, at Hospital Conde Ferreira and at Miguel Bombarda Hospital. The book - structure and contents The book has two parts - "General Part" and "Special Part". In the general part, five chapters on anatomy, physiology, minor surgery, hygiene and pharmacy. The special part, starts with "Definition of alienated and nurse's qualities". "Alienated is an individual who manifests mental disorders, as a rule of an antisocial nature" (p. 133). Considers that " the practice, the common sense and even the convenience of the alienated and the family impose their internment, as soon as possible, in a health house or appropriate hospital. Only in these psychiatric establishments are there conditions favorable to cure or, at least, to their improvements. To assist an alienated person is to dedicate attention and care to him, as if he were an ordinary patient. We should not forget that many alienated people notice the nurse's posture and manner. He therefore needs to be neat, correct and docile. However, in certain cases, it is indispensable to be firm in order to overcome the patient's resistance, after all persuasive words and affectionate gestures have been exhausted. Cold-bloodedness and good education exclude, for useless and counterproductive, brutality. Also one of the great qualities of the nurse is being an observer. During the service, exercising due vigilance, can avoid record unpleasant scenes and dangerous acts and record important notes that will then provide to the doctor. Finally, it is up to him to be obedient to his superiors, carrying out his orders, and discreet, not giving strange reports that harm the patient or families. "(P. 133134). In summary, the nurse's qualities include: dedicating attention and care to the alienated person as if he were an ordinary patient; be careful with the posture and manners. Present yourself neat, correct and docile, firm, endowed with cold blood and good manners. Be an observer, exercise anticipatory surveillance, record occurrences. Be obedient and discreet. In the following chapters, discusses "how to take the patient from home to the hospital", "when the patient enters", the designations (close to the idea of categories) of "Nursing personnel". The struture is similar to a patien path in the House. [71] Proceeds to distribute the alienated according to the "tendencies and reactions of the patients by the reports of the entrance and by the doctor's examination" forming three groups: Agitated, Quiet and Unclean. "In the most important alienated establishments there are still other divisions: semi-tranquil, epileptic and hysterical, criminal, infectious and workers". This typology - "agitated, calm, unclean" -, corresponding to symptomatic evidence, had a functional and organizational purpose and dedicate a chapter to each group. In "the division of the agitated", he pays special attention to the means of restraint, the behavior to be taken when dominating a patient and the placement (exemplified with photographs) of the force vest (p. 139-141) and the wearing of the overalls. «In the division of tranquillizers» refers to clinotherapy - staying in bed - and reinforces the need for vigilance and recommends that nurses "will not abandon the alienated who manifest suicide ideas". «In the division of the unclean», designation given to the "alienated people who usually get dirty with feces and urine" (p. 149), in which the nurse develops measures "against the sad and disgusting spectacle of filth". It points out the risk and treatment of bed sores, which seems to be relevant data, considering the concern with skin integrity. Makes autonomous references to care for "epileptics and hysterics", "alcoholics and morphologists", "serious occurrences" in which it includes self-mutilation (p. 159); «Hydrotherapy», «Dietary regimes», «Writings, drawings and manufactured objects», «Walks, games, readings and other amusements», «Getting up and lying down», «Night watch», «Beard and hair» , «Visits», «Transfers», «Agony and death». Luís Cebola advised nurses to collect and keep all the writings, drawings or paintings made by the patients, favoring expressive and artistic activity. One of his creations was an ergotherapic museum. Notes on the epochal scenario At this time, there were four psychiatric institutions: two public (Manicómio Bombarda and Hospital Conde Ferreira) and two under the responsibility of the Order of S. João de Deus (Casa de Saúde do Telhal, for men, and Casa de Saúde da Idanha, for women). The official teaching of psychiatry was created in 1911, in Lisbon (at Rilhafoles Hospital, later called Manicómio Bombarda), in Porto (at Conde Ferreira Hospital) and in Coimbra (at University Hospital), being the «teaching asylums» also called psychiatric clinics, attached to medical schools as a complement to psychiatry teaching. With regard to psychiatric nursing, the decree of 22 February 1911 had created, months before, a course for nurses and helpers, in Bombarda Asylum. Thus, the regulation of the psychiatric nursing course in February and the official teaching of psychiatry in May, both date from the same year, 1911. The fragility of the republican regime would last from 5 October 1910 to 28 May 1926, with a progressive secularization in the early days and an unsuccessful search for economic development. The transition period from the military dictatorship to the Salazar regime (from 1926 to 1933-34) was already considered as one of the most agitated and complex in our history in this century. In June 1932, after countless conflicts and revolts, António Salazar assumed the leadership of the Government, making the transition to "Estado Novo", a fascist regime that remains until 1974. Conclusions As the author states, there was no manual for psychiatric care nurses. Thus, the book «Nursing of the Alienated» was truly the first Psychiatric Nursing book in Portugal. According to a diachronic perspective, we will be able to verify the passage from the "mad" to the sick, a slow transition from a socio-cultural valorization of madness to the knowledge of mental illness. Let us note, conclusively, the extraordinary vision of Luís Cebola, ahead of his time, especially with regard to ergotherapy, the humanism and delicacy with which the alienated should be treated. Bibliography 1. 2. 3. 4. 5. 6. NUNES, Lucília - Um olhar sobre o ombro. História da Enfermagem em Portugual (1881-1998). Loures: Lusodidacta, 2003. BORGES, Augusto Moutinho; CARDOSO, Ana Mateus; D’OLIVEIRA, Fernando; GAMEIRO, Aires, “Um Republicano no Convento”, Cadernos do CEIS20 [Centro de Estudos Interdisciplinares do Século XX], 13, Coimbra, 2009, pp. 27-28. GAMEIRO, Aires - Evocação de um médico esquecido, o dr. Luís Cebola - pioneiro da ocupação ergoterápica na Casa de Saúde do Telhal, da Ordem Hospitaleira de S. João de Deus. Memória das XX Jornadas de Estudo. Cadernos de Cultura, nº 23, 2009, p. 126-133. GAMEIRO, Aires (coord.) – Casa de Saúde do Telhal. 1º Centenário (1863-1963) Textos históricos e clínicos. Mem Martins: Editorial Hospitalidade, 1993; PEREIRA, Denise Maria Borrega - Visões da Psiquiatria, Doença Mental e República no Trabalho do Psiquiatra Luís Cebola (1876-1967): uma Abordagem Histórica nas Encruzilhadas da Psiquiatria, Ideologia Política e Ficção, em Portugal, na Primeira Metadedo Século XX. Dissertação de Doutoramento em História, Filosofia e Património da Ciência e da Tecnologia. UNL, FCT, 2015. PEREIRA, José Manuel Morgado - A Psiquiatria em Portugal Protagonistas e história conceptual (1884-1924) Tese de doutoramento em Altos Estudos em História, Ramo Época Contemporânea, Departamento de História, Estudos Europeus, Arqueologia e Artes da Faculdade de Letras da Universidade de Coimbra, 2015. [72] 7. 8. PIRES, Ana - “Chamem o José Bernardo!”Uma evocação histórica em cinco atos. Pensar Enfermagem, vol. 18, n.º 1 (2014) p. 40-48. SOARES, Isabel - Notícia sobre alguns manuais de enfermagem In: Enfermagem. - Lisboa. - ISSN 0871-0775. - S. 2, nº 1 (Jan./Mar. 1996), p. 43-52. [73] The use of restraint in an Italian psychiatric Hospital between 1944 and 1947 Valentina Tommasi1, Barbara Bassola2, Maura Lusignani3 1 RN, PhD Candidate, A.S.S.T. Grande Ospedale Metropolitano Niguarda, Italy; 2RN, PhD, A.S.S.T. Grande Ospedale Metropolitano Niguarda, Italy; 3RN, Professor, Department of Biomedical Sciences of Health, University of Milan, Italy The argument of the research is the use of restraint in an Italian psychiatric Hospital between 1944 and 1947. About 1830 in England started the non-restraint movement and spread all over Europe. In Italy in 1904 was issued the law number 36 and in 1909 the Regio Decreto number 615, both concerned the psychiatric Hospital. These laws regulated also the restraint, that wasn’t encouraged or tolerated. Use of restraint was limited to absolutely exceptional situations and to do it was necessary the written authorization from the hospital’s director or from a doctor. The undue authorization of the restraint use could also be punished with a monetary penalty. Before these laws, inside psychiatric Hospital worked guardians, who were usually illiterate and “brutal” and they weren’t recognized by law. Regio Decreto 615 indicated that people could work like psychiatric nurse if they were able to read and write, if they had good physical constitution, if they lived near hospital. Psychiatric nurse had the responsibility of patients in front of the law. In Italy these laws were abolished by the Law 180 of 1978, Basaglia’s law, that abolished psychiatric Hospitals and provided for the creation of places of care and rehabilitation. All regulations regarding restraint were abolished, but didn’t make explicit regulations about restraint. So, from the beginning of XX century, in Italy restraint wasn’t tolerated and recognized like therapeutic means of cure, but what happened inside a psychiatric Hospital about the use of restraint? The aim of this historical research was to investigate the use of restraint in an Italian psychiatric Hospital between 1944 and 1947, examining if and why restraint was done, which instruments was used to do it and which health professionals did restraint to patients. We analyzed files from 1944 to 1947 inside the medical records archive of the ex-psychiatric Hospital “Paolo Pini”, belonging to the historical-clinical section of the Regional Museum of Psychiatric. “Paolo Pini” was constructed between 1921 and 1923 in a place near Milan. The validity of official clinical documents was evaluated with the support of the archivists who had worked on the documents. To understand context and to have information about documents and about psychiatric patients of the years interested in the research we did also two interviews, in particularly to an Archivist and to a psychiatric doctor who did his training at the “Paolo Pini” hospital. Documents are preserved in dedicated rooms inside the old hospital, and are organized in order of date. Some of them are ruined, totally or in part, some of them are not readable, the archivist didn’t report that information. The documents we read for this historical research were the diaries and the “cedole cubicolari”. Diaries were typed and were written usually between 1944 and 1946, “cedole cubicolari” were handwritten and were usually written between 1946 and 1947. In both type of documents, it was possible to find information about restraint, these documents in fact described the clinical life of patients. It was possible to know the number of new admissions in the years investigated: 669 new patients in 1944, 774 new patients in 1945, 894 new patients in 1946 and 1030 new patients in 1947. We analyzed 520 Medical Records. The history of this patients showed that some of patients weren’t admitted for mental conditions. Some of them had different kind of problems, they were marginalized people, poor or people that couldn’t look after themselves. There were 138 different type of diagnosis in documents: the 41% were psychiatric diagnosis, like depression syndrome or paranoid psychosis or manic state, the 49% were not psychiatric diagnosis, like dementia or epilepsy or imbecility, and 13% didn’t have a diagnosis. Restraint interested 46/520 medical records. The number of episodes were 88, so some patients had more than one restraint episode. Of these 46 patients, the 63% had a psychiatric diagnosis, the 24% didn’t have a psychiatric diagnosis and the 13% didn’t have a diagnosis. In documents often the writer is the person who decided about restrain. It’s impossible to know with certainty who wrote diaries and “cedole cubicolari” because it was rarely to find a sign. Archivist and psychiatric doctor who were interviewed thought that nurses wrote this kind of documents. Furthermore, the written sometime presented different kind of written style, errors and informal languages and it’s possible to find expressions like: “More quiet; he presents himself to second infirmary by order of Dottor…”. During the narrations it was also possible to understand that physicians weren’t present in wards, in fact it’s possible to find expression like: “we restrained patient with laces, alerted doctor on call”. Motivations of the use of restraint were aggressive behaviors or acts of not respect of rules. Examples were patients who wanted to go home or they refused to eat or they were aggressive with other patients or worker or their self. In all these situations patients were restrained. The instruments most used to do restraint were wrists laces and sometimes also ankles laces, especially in patients with psychiatric diagnosis. The segregation in cell was also used to restraint patients; this type of architectural restraint was encouraged to use by the non-restraint movement instead of mechanical restraint. In some case there was no indications in documents about the kind of restraint that was used, just expressions like “was restrained”. Also medications were analyzed that were used with the 46 patients that had restraints episodes. In that years, there weren’t psychiatric medications, psychiatric doctors used different kind of medications, especially Electroshock therapy. They also used Gardenal, to sedate patients, insulin-therapy and “pireto-therapy” with the use, for example, of malaria or sulphur. With these substances they tried a sort of patient’s brain reset. They in fact observed that patients became more relax and compliant after therapies. Every patient usual did more than one medication, usually cycles. Some of these patients didn’t do any kind of these therapies, some of them died probably before. [74] We can affirm that between 1944 and 1947 there were poverty and sufferance among the population of Milan; people were scared about war’s events and families sometimes had problems to help their relatives. Psychiatric Hospitals were places to find not only psychiatric patients but also other kind of people, patients with neurology diagnosis or poor people. Restraint was used in the Paolo Pini Psychiatric Hospital and it was an answer of nurses and psychiatric doctors against aggressive behaviors or not respect of rules by patients. It was possible that nurses decided about the use of restraint over patients without physician’s permission. Restraint could cause physical and psychological consequences to patients and was possible that nurses weren’t prepare or in the right number to take care of these patients. It isn’t possible in our knowledge to know how many nurses and doctors were present with how many patients inside the wards of the hospital. Restraint is a deprivation of a person's freedom, which brings with it ethical dilemmas and suffering. This historical research shows the important nurses’ role inside old psychiatric Hospitals. The psychiatric Doctor who was interviewed declared: “The greatest risk in my opinion is delegating to objects a condition of serious sufferance of people, without having the need to enter into a relationship with them, in a human relationship with them. In my opinion, this is the greatest risk of restraint”. Bibliography 1. 2. 3. 4. 5. 6. Babini, V.P. (2009). Liberi tutti. Manicomi e psichiatri in Italia: una storia del novecento. Bologna: il Mulino. Cosmacini, G. (2005). Storia della medicina e della sanità in Italia. Roma-Bari: Laterza & Figli Spa. Tremolada, M. (1981). Una perfezione manicomiale. Immagini per una storia della psichiatria. Torino: Stamperia Artistica Nazionale. De Bernardi, A., De Peri, F., Panzeri, L. (1980). Tempo e catene Manicomio, psichiatria e classi sociali. Il caso milanese. Milano: Franco Angeli Editore. Canosa, R. (1979). Storia del manicomio in Italia dall’unità a oggi. Milano: Giangiacomo Feltrinelli Editore. Cazzani, E. (1952). Luci ed ombre nell’ospedale psichiatrico provinciale di milano. Varese: Cisalpino. [75] Peer support: New forms of caring work in late 20th century psychiatric mental health care Geertje Boschma, Courtney Devane University of British Columbia, Canada Patients influenced change in nursing practice and mental health care in the late 20th century. From the 1970s onwards, they had an essential role in enacting new forms of citizenship and peer support. Within a discourse of self-help, patient rights, rehabilitation, and recovery they became a driving force in the development of peer support, which emerged as a new resource and a new field of caring work in mental health services, particularly from the 1990s onwards. Identifying as survivors or consumers, patients critiqued the existing healthcare system and they took on activist roles in the change of services to better meet their needs. They organized themselves, for example in the Mental Patients Association (MPA) of Vancouver, Canada, established in 1971. The MPA constituted the first such organization in Canada and joint an international movement for patient rights and liberation. Using oral history, archival evidence and secondary sources, this paper highlights within the Canadian context how, in the 1970s, the patient liberation movement transformed the role and influence of patients in mental health. The paper explores the history of peer support and the way it became incorporated not only as an accepted form of work in mental health services, whether voluntary or paid, but also as a key component of mental health policy as of the 1990s. The history of Vancouver's MPA, highlighted in this presentation as an early and original case example of peer support, illuminates how patients helping each other found a cultural niche and has become a firmly established part of mental health service and health policy. It also shows how, from the 1990s onwards, pressures to professionalize peer support also generated new challenges and sometimes contradictory views on the way peer support should be enacted, whether peer supporters should be seen as peers versus workers, for example, or whether it should be enacted as a communal or an individualized form of peer support. As peer support developed into its more individualized form, into a formalized position, it not only created a new form of work and social inclusion, but it also generated new expectations of training and certification and it became incorporated into a discourse of recovery. The paper concludes that peer support not only extended to new forms of employment, citizenship, and meaningful work, but also to new understandings of healing and recovery. Peer support, whether volunteer work or paid employment, represents new professional and consumer identities. These initiatives also influenced the work and role of nurses in mental health, interrupting traditional hierarchies, and influencing, for example, new ways nurses engaged with relational practice and recovery oriented care. In this process of transformation tensions between work and mental illness have not disappeared and debate over the place, implementation, operationalization, impact and value of peer support continues to this day. Despite these complexities, peer support has become an integral part of mental health services. For a full discussion of these developments and the evolution of peer support in BC see: Geertje Boschma and Courtney Devane. The art of peer support: Work, health, consumer participation and new forms of citizenship in late twentieth century mental health care in British Columbia (BC), in: BC Studies, no. 202 (Summer 2019): 65-98. Authors: Geertje Boschma, PhD, RN, and Courtney Devane, MSN, RN. Contact info: School of Nursing, University of British Columbia, T201 - 2211 Wesbrook Mall, Vancouver BC V6T 2B5, Canada. Contact E-mail: geertje.boschma@ubc.ca Bio info: Geertje Boschma is a professor at the University of British Columbia School of Nursing. Her research centers on the history of nursing with particular emphasis on the history of mental health and psychiatry; she is lead faculty of the Consortium for the History of Nursing Inquiry at the UBC School of Nursing. Courtney Devane is doctoral student at the UBC School of Nursing and an expert clinician in mental health nursing. Her dissertation research focuses on the development of peer support in mental health services with a specific focus on youth peer support. Bibliography 1. 2. Geertje Boschma and Courtney Devane. The art of peer support: Work, health, consumer participation and new forms of citizenship in late twentieth century mental health care in British Columbia (BC), in: BC Studies, no. 202 (Summer 2019): 6598 Boschma, G. (2019). Electroconvulsive therapy (ECT) and nursing practice in the Netherlands, 1940 – 2010. European Journal for Nursing History and Ethics, 1, 17-39. doi: 10.25974/enhe2019-7en https://www.enhe.eu/ [76] Call the Midwife, 1957-1960's: Portrayals of an era and professional practice Carolyn Jean Lee University of Toledo College of Nursing, United States of America I am pleased to share my interest in the period television drama, Call the Midwife (CTM). As a nurse educator, I am intrigued by the plotlines, characters and, especially, the dramatic portrayal of midwifery and nursing practice to the people of Poplar, in the East end of London in the 1950’s and 1960’s. I am particularly interested in the possibilities of the program as an educational tool and its value in engaging the students with the past as context for today. The BBC produced television series, that has aired for eight seasons with two additional season contracts in place, is readily available to viewing audiences in the United States. The series is based on the 2002 memoir of Jennifer Worth, who had practiced midwifery in the East End with the St. Joseph’s order. The program also draws content from the other books in the trilogy, Farewell to the East End and Shadows of the Workhouse, also have content drawn for the series. It is important to recognize that the program is based on a memoir and the newer series content is long past the time represented in the book. While the series represents well-researched content, we must be mindful that it is a television show designed for the entertainment of and appeal to the viewing audience. Today’s nursing students hold a fondness for media and expect teaching approaches that they can relate to. Fifty-plus years of literature on the use, or potential use, of television have described possibilities to engage students, blend entertainment with learning and to examine professional roles. With careful selections, nurse educators can adopt these sources to examine clinical practice, consider ethical issues, explore health care roles and reflect on core values. I contend that CTM has the potential to do so with the added benefit of care provision to women but also to family, community and each other. There is so much content about becoming a nurse, midwifery expertise, working in ‘the real world’ with many topics pertinent to the modern curriculum. My goal is to consider the series through the possibility of developing a nursing elective course with didactic content in the sophomore or junior year of study and, ideally, a senior year study abroad intensive experience focused on studying UK midwifery practice and the UK Health Care System as compared to the United States. There is meaningful series content that remains relevant to capture the interest of the contemporary student. For example, content on the introduction of oral contraceptives to the UK in 1961 and past management of abortion relate to contemporary conversations about reproductive health rights and access to care. As students study safety and mechanisms for drug approvals, episodic content centered on the drug thalidomide, banned in 1961 due to the occurrence of devastating birth effects, provides historical context about medication safety. Content on social issues of the day, such as marriage across racial and cultural groups, remain germane and a story line about a midwife, who as a lesbian has to hide her relationship, tie into current dialogue about acceptance of others and improvements needed in care provision to LGBTQ+ populations. The project at hand is the conduct of a systematic review of program content in preparation for proposing a nursing course. The content is being examined using the International Confederation of Midwives code of ethics as an organizational tool. The ICM Code considers midwifery in Elements 1-4: midwife relationships, practice, professional responsibilities and advancement of the profession. The details of the ICM Code coordinate well with sources used in U.S. nursing education such as The American Nursing Association Code of Ethics, professional organizations standards of care and Quality and Safety Education in Nursing (QSEN). Current program is being analyzed on a grid in which the season, time within the episode, a brief description of program content and its relationship to the ICM Code Element and sub-elements are noted. The use of the CTM series also aligns well with the Social Determinants of Health Model Categories (neighborhood/built environment; economic stability, health/health care, education and social/community context) that are stressed as content areas in present nursing education curricula. I would like to share two exemplars from CTM episodes that are valuable illustrations to students of the work of nurses/midwives and conveys the importance of the personal and social circumstances of those we care for. In the first episode, midwives Jenny and Trixie encounter Pearl Winston, an antepartum patient who reports at the clinical to having “ a shocking discharge, which is diagnosed as a sexually transmitted disease. Repulsed by her assessment findings, Jenny is found by the experienced Sister Julienne to be scrubbing and rescrubbing her hands, is told that “she can’t catch it”. When Jenny asks how a patient could ignore such symptoms and how people can live like this, she is mentored by the wise sister who thoughtfully replies, “Pearl Winston isn’t used to caring or being cared about” and “But they do and that is why we are here”. Another colleague tells Jenny that, as a novice, she thought the midwives deserved ‘all medals of honour’ but now realizes it is the brave women of Poplar weathering on despite their circumstances who are brave. Pearl eventually loses her pregnancy and when Jenny comes for a home visit, she has gained new insights telling Pearl the women of Poplar are the heroes after which she is invited for a cup of tea in one of Pearl’s few valuables, her grandmother’s china teacup. In this episode and the series, there are many examples by which the midwives survive and advance in their professional and selfworth via collegial support (Code 1/E). Code 1/F is represented when Jenny recognizes a syphilitic chancre on nursing assessment, engages with a more knowledgeable nurse and engages Dr. Turner for medical management providing an example of interprofessional collaboration that is so stressed today. In reconnecting with her patient, Jenny applies Code Element II/D in responding to the care needs of her patient within her circumstances. In just this one episode, we can connect students back to didactic content on antepartum care, sexually transmitted disease, patient support and education. If not in a freestanding elective, such content exemplars readily connect with concepts in women’s health, population health, pathophysiology and pharmacology courses. A second exemplar shares the experience of Peggy and Frank, a brother and sister separated as children in the workhouses of London. As the young midwives engage in gossip when Jenny notices only one bed in the modest but well-kept home of Peggy and Frank, they are confronted by the older Sister Evangeline who notes “I imagine none of you girls have every been in a workhouse, they were designed to break the spirit, worse than dying, that’s what anyone whose been in one said”. She reports they were separated for years and “it’s not surprising they clung together for dear life. Their love was the only good thing that came out of that place”. When midwife Cynthia says, “But Sister, it’s incest’’, Sister Evangeline retorts with “There was nothing left of family the minute they walked [77] through those gates”. When Frank is diagnosed with terminal cancer, the nurse role is to be present for the family in their grief and loss and to educate Peggy about comfort measures for her brother. Both Frank and Peggy ask the nurses not to tell the other about the prognosis, investing trust in the nurse-patient relationship. Code Element 1/B is demonstrated in the support of the health care team in caring for Frank according to his wishes and to support Peggy in the care of her brother. Midwifery code III/A is demonstrated in that the midwives are respectful of the family wishes. This episode is very emotional and heartfelt. The dedication of the midwives to the family and the family members to each other is striking. The nature of Peggy and Frank’s relationship may lend itself to controversy, but students must learn that working in health care exposes us to the complexity of the human experience. Nurses must learn to negotiate through personal responses to complex situations and ethical dilemmas that can potentially influence their care relationships and practices. This episode conveys the provision of thoughtful palliative care and being non-judgmental in our patient encounters. This content illustrates the importance of palliative care exposing students to the unique responsibilities and rewards of this career path. The program readily aligns itself with models such as the ICM Ethical Code for midwives, best practice standards and relates well to the Social Determinants of Health and is applicable to a variety of curricular content areas in women’s, family, pediatric, population health, role development and ethics courses. As such, the author endorses its use as an educational tool. In conclusion, CTM is a compelling series with any number of avenues to illustrate the practice of nursing and the human experience to students. (The author is grateful to The University of Toledo in the award of a Kohler International Travel Grant in support of conference participation). Bibliography 1. 2. 3. 4. 5. 6. 7. 8. Mitchell, K., Phillips, K, Pocotte, S. & Lee. C (2019). The Creation of a White Coat Ceremony. Journal of Professional Nursing. In-press. Gibbs, K., Lee, C. & Ghanbari, H. (2019). Promoting faculty education on needs and resources for military-active and veteran students. Journal of Nursing Education, 58(6), 347-353. Lee, C., Ahonen, K., Navarette, E & Frisch, K. (2015). Successful Student Group Projects: Perspectives and Strategies. Teaching and Learning in Nursing, 10(4), 186-191. Lee, C. (2014). Use of Student Photography to Explore Nursing. Nurse Educator (39)4. Lee, C., Ahonen, K., Apling, M. & Bork, C. (2012). Emergency contraception knowledge among nurse practitioner students. Journal of the American Academy of Nurse Practitioners, (24)10, 604-611. Lee, C. & Grady, M. (2012). Gather ye rosebuds while ye may : A college of nursing history project. Nurse Educator, (37)5, 222-225. Lee, C. (2012). “Momma’s hands”. International Journal for Human Caring, 16, 1. Ahonen,K., Lee, C. & Daker, E. (2012). Reaping the harvest: Nursing student involvement in a community gardening project. Nurse Educator, 37(2), 86-88. [78] Nursing in Estonia and its Initiators in the Context of Florence Nightingale’s Ideas Merle Talvik1, Taimi Tulva2, Ülle Ernits3 Tallinn Health Care College, Estonia; 2Tallinn Health Care College, Estonia; 3Tallinn Health Care College, Estonia 1 Keywords: history of Estonian nursing, Florence Nightingale, Anna Erma, Anette Massov, Ilve-Teisi Remmel 1. Background of the research This is a historical-cultural survey of the ideas of Florence Nightingale (1820–1910), the founder of theoretical and practical bases of nursing, in the Estonian context. Nursing developments in one country expanded to other countries and influenced them. The history of nursing in Estonia goes back to 1700s, when deaconesses took care of the weak and the sick. Preparation training of nurses was initiated only in the second half of 19th century (Sooväli, 1998). It was the time when Nightingale’s ideas spread in Europe. Nursing developments in Western Europe, Scandinavia, Russia and the Baltic States demonstrate the contextual background, in which Estonian nursing was started and progressed. Development of nursing has been influenced by social, historical-cultural, political and ethnic factors. The aim of the research is to analyse the development of nursing and the activity of the initiators of nursing in the reflection of Florence Nightingale’s ideas in Estonia. The following research questions were formed based on the aim: - What kind of influence has Estonian nursing gained from historical experiences and how have these ideas shaped modern nursing? - How did the initiators in Estonian nursing follow the ideas of Nightingale? Thus, the question of how nursing and nurses’ training evolved in the context of societal change became a research issue considering our country’s cultural identity and social diversity. 2. Method Historical research method was used to analyse nursing history in Estonia. The content analysis of historical documents was conducted between 2017 and 2019. Biographical material about Estonian nurses from the collections of the Estonian Healthcare Museum was also used. According to Carr, the present can be learned in the light of the past and the past in the light of the present. According to him, the task of historical science is to promote a deeper understanding of both, past and present, by exploring the relationship between them. (Carr, 1965: 56–86) All historical periods are interrelated and have an impact on the present day and the future. 3. Results The results of the research allow to point out the following: there were four developmental periods in the history of Estonian nursing in which the initiators emerged. 3.1 Periodisation of the development of Estonian nursing The first period is characterised by the teaching of nurses at churches and monasteries. This first period up to 1918 could be called a religious period. In the mid-18th century, the first nurses who had been trained in Russia came to work in the newly opened hospitals in Estonia. During the period of the first Republic of Estonia (1918–1940) the profession of a nurse was characterised by high prestige. There was a wide network of international contacts. Continuous training of nurses began, facilitated by the formation of Estonian Nurses Association. This period can be called a period of openness and professionalism. During the period of Soviet regime (1940–1991) nurses lost their professional standing and were trained in vocational schools. Suppression and hierarchy characterise this period – nurses were pushed down to the status of assistants. Medical schools were in several Estonian towns and operated under different names that were changed according to political decisions. Training of nurses during the period after the restoration of independence (since 1991) underwent rapid changes. Nurses’ training was adapted to professional higher education and to bachelor level. Master’s degree studies were launched in the University of Tartu in 1998, and at Tallinn and Tartu Health Care Colleges in 2018. International relations were restored, and European curricula developed in cooperation with Nordic colleagues. The educational challenges of the present-day free and democratic Estonia have emerged from our developmental story and social peculiarities. 3.2 Nursing initiators as queens of nurses Florence Nightingale is called the queen of nurses (Shetty, 2016: 144). The preconditions for becoming a queen were: good education and ability to speak many languages; involvement as a nurse in the Crimean War (1853–1856); being the first nursing theorist; pioneering the concept of education for nurses; taking initiative to reform health and sanitation; being a methodical researcher and a futurist and having written ca 200 books. Students came from all over the world to attend Nightingale Nurse’s Training School at St. Thomas’s Hospital, founded in 1860. After completing their studies they returned to their home countries, mostly as managers and educators. [79] Nightingale’s ideas and principles have been applied in the last three periods of nursing development in Estonia. The realisation of ideas has been led by three queens of Estonian nursing – Anna Erma, Anette Massov and Ilve-Teisi Remmel. Anna Erma (1884–1974) studied nursing in St. Petersburg and took theoretical courses in Germany, England and France. During the World War I (1914−1917), she was a nurse in military hospitals. She dedicated her entire life to her profession. In 1925, when the Nursing School was established at the University of Tartu, Anna Erma was invited to run it. Training at the Nursing School was based on religious principles, just as Anna Erma had always learned. She applied Nightingale’s principles, especially on how to educate a woman into a good nurse and how to create the right environment for the patients (Nightingale, 1859/2018). Anna Erma laid the foundation for the systematic development of Estonian nurses’ training (Reinart, 2019: 12). She was one of the founders and the first and only pre-war president of the Estonian Nurses Association (founded in 1923). The Soviet occupation terminated the association’s activities in Estonia in 1940 and the activities of the Nursing School in 1941. In 1944 many Estonian intellectuals and state figures fled their homeland, including Anna Erma. She fled to Germany. In 1950s she moved to Brazil and worked in the field of charity. Anette Massov (1883–?) learned to become a sister of mercy. In 1904 she worked as a nurse in the Russian–Japanese War and was awarded with the Russian Red Cross badge and a gold medal from the emperor. She healed the wounded during the World War I and in the War of Independence (1918–1920). She was the head nurse at Tallinn Central Hospital for 35 years. She gave a „Nightingale content” to Estonian practical nursing. In 1939, the Florence Nightingale Medal was awarded to Anette Massov (Põder, 1995). She is the only Estonian who has received this medal. The year of the death of Anette Massov is unknown, she disappeared during the World War II. During the period of Soviet regime, the previously built nurses’ training system was demolished like many other education systems. The views of Nightingale were transmitted from person to person, from nurse to nurse. Since the 1980s the ideas of the Western world infiltrated through the Iron Curtain and the third queen of Estonian nursing, Ilve-Teisi Remmel (born 1938), emerged. She worked for a long time as a practicing nurse in Tallinn hospitals and was the president of Estonian Nurses Association from 1988 to 2002. Remmel began to innovate nursing in a newly independent Estonia, for three years (1990–1993) she was the president of the Baltic Nurses Association. Through her work, she conveyed Nightingale’s philosophical ideas to the nurses, organised seminars and conferences on the subject. Remmel supported strongly and consistently the development of nursing education at higher educational level. In a new context, Nightingale’s ideas reappeared, especially with regard to nursing philosophy and research. 4. Discussion and conclusion Nightingale’s ideas have been developed in Estonia for more than 100 years. In 1875, as an elderly and experienced woman and headmaster, Nightingale wrote to her graduates the following lines, what became an important credo of her life’s work: „A woman with a healthy, active tone of mind, plenty of work in her, and some enthusiasm, who makes the best of everything, and, above all, does not think herself better than other people because she is a „Nightingale Nurse”, that is the woman we want” (Nightingale & Nash, 1914: 108). We also pursue this endeavor in the training of our nurses. Nightingale’s ideas about the patient-centered care survived despite the difficult times, withstood the winds of change in the society and received sustainable development under the leadership of the initiators of Estonian nursing. References Carr, E. H. (1965). What is history? Harmondsworth: Penguin Books. Shetty, A. P. (2016). Florence Nightingale: The queen of nurses. Archives of Medicine and Health Sciences, 4, 1, 144–148, Jan–Jul. Sooväli, E.–M. (1998). Õenduse ajalooline ülevaade maailmas ja Eestis, Eesti Õde, 1, 18–19. Nightingale, F; Nash, R. N. (1914). Florence Nightingale to her Nurses: a Selection From Miss Nightingale’s Addresses to Probationers and Nurses of the Nightingale School at St. Thomas’s Hospital. London: Macmillan. Nightingale, F. (2018). Notes on Nursing. What it is and what it is not. New York: Dover Publications. (First published London, 1859). Põder, M. (1997). Esimene ja seni ainuke Florence Nightingale’i medali pälvinud eesti õde – Anette Massov. Eesti Õde, 2, 18. Reinart, H. (2019). Eesti haiglaõdede esiema. Postimees. Arter, May 11, 12–14. Bibliography 1. 2. Ernits, Ülle; Talvik, Merle; Tulva, Taimi (2019). Nursing Education in the Wind of Changes: Estonian Experience. In: Proceedings of the International Conference on Research in Education (1−14). Barcelona, Spain: Diamond Scientific Publication. Talvik, Merle; Talvik, Mati; Talvik, Martin (2014). Estonian high-school students’ increasing pessimism in predicting solvability of global problems. Journal of Education and Human Development, 3 (3), 25−38. [80] From one district nurse to a comprehensive public health service - success factors in community nursing around 1900 Mathilde Hackmann Evangelische Hochschule für Soziale Arbeit & Diakonie Hamburg, Germany Background In the second half of the 19th century the City of Hamburg expanded its boundaries. After the opening of the city gates in 1860 new districts grew outside of the walls and new protestant parishes emerged (Overlack 2007, 38). In 1882 the protestant parish St. Gertrud was founded and a progressive pastor was employed not without conflicts between the church leaders of the city (Staatsarchiv Hamburg 513-4-IV). Development of services in St. Gertrud Gemeindepflege In 1885 this pastor, Dr. Carl Manchot, founded St. Gertrud Gemeindepflege, a registered charity starting with one qualified nurse offering home care. During the next years services expanded to the following: • • • • • • 1885 - home nursing / district nursing (1 nurse) 1889 - milk kitchen (3 nurses in 1890) 1892 - children's home during the cholera epidemic - closed after a couple of months 1895 - home for convalescent children (6-12 beds) (5 nurses) 1904 - hospital (14 - 20 beds) (12 nurses) 1911 - rooms for infant welfare clinics In May 1885 nurse Clara Werner was sent by the Red cross sisterhood in Hamburg to the parish for the service of home nursing / district nursing. The yearly reports give evidence on the work that was done. During the first year nurse Clara made 2149 visits to ill people in their homes (Jahresbericht 1885, 3) with an average of 10 to 12 visits per day (Jahresbericht 1885, 4). She regularly consulted with the district doctor (Jahresbericht 1885, 4), a service provided by the City of Hamburg for the poor. The report of 1885 gives examples of the poverty of people in the parish. A second nurse (nurse Mary) started work in October 1887 (Jahresbericht 1887, 2). Observing poor nourished infants the now two nurses convinced the board of directors to initiate a milk kitchen providing sterilized milk for malnourished infants in the families. The milk kitchen was supervised by the physician Dr. Carl Manchot, the son of the pastor. Documentation concerning the children was very advanced and Dr. Manchot who conducted research on infant mortality could prove that infant mortality in the area of the parish St. Gertrud was lower compared to the statistics of the City of Hamburg (Manchot 1905, 17 ff). During the cholera epidemic in summer 1892 Pastor Manchot initiated a children's home which was closed after a couple of months (Manchot 1892). But the experiences led to the establishment of a convalescent home for children, starting with 6 beds (later 12 beds) in 1895. In 1904 enough money could be raised to build a private hospital (14 - 20 beds) working with doctors from outside. Although parts of the building were used as a military hospital during World War I the hospital was able to provide the private beds during that time and raise some money (Jahresbericht 1915). Infant welfare clinics started with the milk kitchen and Dr. Manchot's services and research were expanded to a regular service in 1911 when special rooms could be provided (Jahresbericht 1911). In 1922 all services were still in place. Home nursing was provided as usual. The hospital now had 40 beds, the milk kitchen still worked, the children's convalescent home had been modified to a day home and a nursery school. Infant welfare had become a topic for state welfare in 1920 and was therefore regularly financed from that time on. St. Gertrud Gemeindepflege now offered a wide range of public health services (Hinrichs 1922). Support from the public Starting in 1885 the service relied heavily on donations of parish members, the occasional legacy and subscribers, starting with 189 persons listed in the yearly report (Jahresbericht 1885, 7 f). By 1913 the number of subscribers had risen to more than 1,700 (Jahresbericht 1913). Although the City of Hamburg and insurances increasingly supported the services the donations of money but also of food and equipment show the great interest of the local community to support St. Gertrud Gemeindepflege. Groups of volunteers like young women organized in a sewing club by the wife of Pastor Manchot and sewing children's underwear for poor families show the strong connection to the protestant parish (Jahresbericht 1885, 5). The leaders of St. Gertrud Gemeindepflege A crucial factor to the increasing success werde the leaders. First of all this was Pastor Dr. Carl Hermann Manchot (1839 - 1909). He must have been a strong character because his inauguration was not approved by all of the pastors in Hamburg (Staatsarchiv Hamburg 513-4-IV). For some of them Pastor Manchot was too liberal in his views. Nevertheless he started working in St. Gertrud on 27th of February 1883 and stayed in office until his death in 1909. Then the nurses are important, first of all the pioneer nurses of the first years. Unfortunately not much is known about them. Clara Werner, the first nurse, was called back by her motherhouse because of illness in 1886 and replaced by nurse Erna (Jahresbericht 1886, 2). Some information of the head nurses has survived in the archives of the Red cross sisterhood in Hamburg. The nurses' workbook (Schwestern-Hauptliste) provides information on the work placements of the nurses, covering nurses from 1902 - 1937. [81] The post of head nurse in St. Gertrud Gemeindepflege was introduced in 1895, starting with Hedwig Schwieder (* 1868) (SchwesternHauptliste) who hold this post for 24 years retiring to the motherhouse in 1919 (Jahresbericht 1919). Head nurse Lina Wendt (* 1870) followed. Being in St. Gertrud as a nurse from 1916 on, she hold the post of head nurse up to 1935 when she retired (SchwesternHauptliste). Meta Zimmermann (* 1890) had been in St. Gertrud in 1918 and from 1921 to 1924. Following Lina Wendt she acted as head nurse for only four years. All nurses were called back from St. Gertrud by the Red cross motherhouse when the war started on the 1st of September 1939 (Schwestern-Hauptliste). A last leader has to be mentioned. The medical doctor Dr. med. Carl Manchot (1866 - 1932), the son of the pastor supervised the milk kitchen. Without his support, his scientific interest and his research the success of the milk kitchen and its impact on the foundation of further services for infants might have been smaller. Conclusion and further questions In conclusion the success factors are strongly interwoven. The qualified Red cross nurses recognized the undernourished infants. This led to the establishment of a milk kitchen. Research of Dr. Manchot revealed the effect of the milk kitchen. The development of services was supported by the local community and the subscribers providing funds. Volunteers supported the home nurses by providing food and equipment. The service was strongly linked to the parish although the work was done by Red cross nurses and not deaconesses. Some of the leaders were in service for more than two decades. But new questions are emerging. Why did the board decide to work with Red cross nurses and not with deaconesses? Who were the persons on the board of directors? How did the board of directors influence the service? Which leadership styles were used by the leaders? How were working conditions for the nurses? It could be useful to compare this example of a success story with other institutions in Hamburg, on a national or an international level to reveal similarities and / or differences in the service. References Hinrichs, M. (1922): Handbuch für den Hamburger Wohlfahrtspfleger. Hamburg: Greve & Tiedemann. Manchot, K. (1892): Vom Kinderheim auf der Uhlenhorst. Eine Hamburger Weihnachtsschrift. Hamburg: Verlag von Otto Meißner. Manchot, C. (1905): Die Milchküche der St. Gertrud Gemeindepflege in Hamburg 1889 - 1904. Hamburg: Verlag von C. Boysen. Overlack, V. (2007): Zwischen nationalem Aufbruch und Nischenexistenz. Hamburg: Dölling und Galitz Verlag. Bibliography 1. State Archives Hamburg - Staatsarchiv Hamburg - 513-4-IV - Begründung der ersten Pfarrstelle und Einführung des Pastor Manchot 1881-1883. 2. St. Gertrud Gemeindepflege - Jahresberichte (yearly reports) 1885 - 1920. [82] 90 Years of organised activities of nurses in Slovenia Irena Keršič, Darinka Klemenc, Monika Ažman, Marjeta Berkopec Nurses and Midwives Association of Slovenia, Slovenia The article will present the professional character and work of Angela Boškin, the first educated nurse in Slovenia. She was born in Peuma in Italy near Slovenian board. She was so called “caregiving” nurse and »protective« nurse, the precursor of today's nurses in Slovenia and also in ex-Yugoslav region. She marked the beginning and the rise of modern nursing and nurse profession in our country. She is considered as the initiator, not only of healthcare but also of social care. Regarding her professional work she is considered the forerunner of today's community nurses. Two facts significantly affected her life and work: the break-up of the AustroHungary monarchy, the country in which she was born, acquired the qualifications for a nursing care and attended the profession as a “caregiving” nurse, and the beginning of professional work in the newly established country of the Kingdom of Serbs, Croats and Slovenes, in which there was no legal basis for the newly created profession. The article will present: her education, her jobs, the content of her professional work, the role and work in the professional association of nurses and the contribution to the development of professional health education. Angela Boškin participated in the establishment of the first school for nurses and the first professional organization of nurses in Slovenia. By establishing maternity and baby consultations in Jesenice in 1919 and implementing health education work, she has already significantly affected to the healthcare system and has influenced to the social and health care, especially to vulnerable groups of the population. The data for the presentation were obtained from available literature, especially the bibliography and published articles, by reviewing her legacy owned by her relatives, examining her legacy, including two decorations, from the interview with Angela Boškin, presented by national television and from a review of archives kept in the Nurses and Midwives Association of Slovenia. Bibliography // [83] Storia dell’infermiere nella provincia di Treviso: le radici come espressione di un’identità professionale autorevole Alberto Coppe1, Michela Bottega1, Giannina Sanzovo1, Silvia Tonon1, Savina Casonato1, Paola Bernardi1, Benedetta De Pin2, Cristina Santin1 1 ULSS2 Marca Trevigiana, Italy; 2University of Padua Background Nel 2017 nasce l'ULSS2 Marca Trevigiana e l’Unità Operativa Complessa delle Professioni Sanitarie che comprende circa 5259 professionisti. Ad oggi sono iscritti all’OPI TV circa 5538 infermieri. Metodi Ricerca storica da: archivi dell’Ospedale, Scuola Convitto, Università degli Studi di Padova-sede di TV, OPI di TV. Risultati Risale al IX secolo la più antica testimonianza di presenza di ospedali a TV. Dal 1269 la confraternita dei Battuti all'interno dell'Ospedale si prodigava per fornire assistenza medica. Nei secoli XV- XVI sono documentati gli “infermier”, lavoratorari non specializzati e volontari di ambo i sessi. Il 15 ottobre 1907 con l’Ordine delle Dorotee si apre la Scuola Samaritana. Nel 1918 il codice disciplinare declina il ruolo di vigilanza e assistenza degli infermieri. Nel 1919, fu istituita la figura del Primo Infermiere, ruolo assegnato ad Adelio Gamboni, considerato “persona di ottime qualità, intelligente, pratico e dotato di buona volontà”. Il 1 dicembre 1932 nasce la prima scuola per infermiere a S. Maria dei Battuti ed il convitto era dislocato altrove; dal 1935, è trasferito nell'Ospedale di S. Maria e dal 1959 nell'Ospedale Cà Foncello-TV. Nel 1968 la Scuola per Infermieri Professionali ed Assistenti Sanitarie si trasferisce a Villa Carisi, diventatando Istituto Professionale S. Bertilla, che si trasforma in DUSI nel 1992. Alla chiusura della Scuola: 2289 diplomi infermiere professionale, 400 certificati di abilitazione a funzione direttive e 113 diplomi assistente sanitario. L’opera di Suor Bertilla Boscardin delle Dorotee offre una testimonianza di santità al Cà Foncello di TV e nel 1961 è stata proclamata “Patrona di tutti gli infermieri e medici che esercitano la loro missione sanitaria nella diocesi di Treviso”. Dal 1996, il Corso di Laurea- sede Universitaria di Treviso ha laureato circa 1400 infermieri. Discussione e conclusione L’excursus rappresenta un patrimonio professionale ed umano dell’infermiere nel territorio trevigiano. Bibliografia 1. 2. Pupo C. (2012) Villa Nini- Una dimora di pregio al servizio della comunità Sartor Ivano (2010) S. Maria dei Battuti di Treviso L’Ospedal Grando Sec. XIII-XX [85] Il tempo e la chiave: memorie del manicomio attraverso le storie degli infermieri (dal 1946 al 1978) Roberta Accardo, Giuliana Pitacco, Daniela Babich, Cristina Brandolin, Giorgio Lo Nigro, Gabriella D'Ambrosi, Claudia Fantuzzi Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI), Italy Background Grazie al lavoro di Franco Basaglia e dei suoi collaboratori, è stata promulgata la legge 180/78, poi inclusa nella legge quadro di Istituzione del Servizio Sanitario Nazionale, che sanciva la definitiva chiusura degli Ospedali Psichiatrici e l’inizio dell’assistenza territoriale per la Salute Mentale, ritornando finalmente alle persone con disturbo mentale i diritti civili. Il Dipartimento di Salute Mentale (DSM) di Trieste conserva un importante archivio storico relativo al periodo della riforma psichiatrica basagliana, che è iniziata proprio qui negli anni ’70. Nonostante gli infermieri abbiano giocato un ruolo determinante nell’attuazione della riforma, il loro punto di vista è stato poco indagato e documentato. Il rinvenimento nell’archivio storico di 9 trascrizioni di interviste, condotte all’inizio degli anni 2000 a 7 infermieri psichiatrici (5 uomini e 2 donne) che hanno lavorato nell’Ospedale Psichiatrico Provinciale di dal 1946 al 1978, ha rappresentato un’importante opportunità per valorizzare l’esperienza degli infermieri psichiatrici nonché aggiungere un ulteriore tassello alla storia dell’istituzione manicomiale e al suo superamento. L’analisi approfondita delle trascrizioni è stata effettuata da alcuni coordinatori del DSM ed ha costituito lo starter di ulteriori approfondimenti riferiti all’esperienza infermieristica negli anni successivi. Obiettivo Descrivere l’esperienza lavorativa ed umana degli infermieri psichiatrici triestini nella fase di transizione dall’ospedale psichiatrico chiuso al nuovo sistema aperto, conseguente alla Legge 180/78 (c.d. “Legge Basaglia”). Materiali e metodi I testi rinvenuti costituiscono la trascrizione fedele e puntuale di interviste videoregistrate (video non conservato), contengono pertanto termini dialettali, errori grammaticali, ridondanze, pause, interiezioni, annotazioni di manifestazioni emotive (pianto, riso, gesti, …). Su questi testi è stata condotta un’indagine qualitativa: 7 infermieri ricercatori (6 afferenti al DSM e 1 “laico”) hanno analizzato, dapprima individualmente le 9 trascrizioni selezionando le occorrenze ritenute più significative; successivamente, i ricercatori, riuniti in seduta plenaria hanno identificato 6 categorie core e 35 relative sotto-categorie, che hanno consentito la creazione di una mappa concettuale dei vissuti esperienziali. Risultati La ricchezza del materiale avrebbe consentito di rintracciare molti nuclei tematici, si è deciso di privilegiare le categorie che meglio rappresentavano l’esperienza degli infermieri, troppo spesso trascurata nei documenti già pubblicati: • • • • • • Relazioni dell’infermiere Figura dell’infermiere Malati Istituzione Trattamenti Fase del cambiamento Tutti i racconti si soffermavano a lungo sul “tempo”, che scandiva tutti i rigidi rituali dell’ospedale psichiatrico e quello richiesto dal cambiamento e sulla “chiave”, intesa in senso reale (il mazzo di chiavi che gli infermieri si scambiavano al cambio turno per accedere a tutto ciò che veniva conservato e custodito in luoghi chiusi, ma anche in senso figurato per aprire le “teste” degli operatori, ancor prima delle porte del manicomio. Le relazioni dell’infermiere Le relazioni all’interno del manicomio seguivano le regole rigide e gerarchiche tipiche delle istituzioni totali: la comunicazione era ridotta al minimo, ogni informazione veniva filtrata e controllata. Erano imposti il silenzio ed il divieto di qualsiasi forma di relazione con gli internati; tuttavia, queste indicazioni venivano spesso disattese e si instauravano legami, anche significativi, con alcuni malati, soprattutto con quelli meno gravi. Ciascun operatore doveva rimanere nel padiglione di assegnazione, la visita ad uno diverso poteva avvenire solo a fronte di un ordine superiore, il divieto era tassativo tra le sezioni maschile e femminile. [86] Gli operatori esperti esercitavano un forte potere nei confronti dei “novizi” che, in alcune situazioni, si connotava come “nonnismo”. L’organizzazione favoriva l’instaurarsi di diffidenza, incertezza e sfiducia reciproca. L’istituzione conferiva all’infermiere un potere molto forte nei confronti dell’internato, che poteva sfociare in situazioni di mortificazione e violenza. Più che di assistenza si trattava di custodia finalizzata a garantire l’isolamento dell’alienato dal contesto sociale, come stabilito dalle norme vigenti agli inizi del ‘900. La figura dell’infermiere L’assunzione in manicomio non richiedeva particolari capacità o conoscenze specifiche; l’infermiere vi “approdava” a seguito delle proprie vicende personali, le più diverse, che lo portavano ad accettare questa occupazione. Il requisito principe era la “prestanza fisica”. La posizione di potere all’interno della struttura era rappresentata dalla divisa e, soprattutto, dalle chiavi, che consentivano di decidere se far stare gli internati in comunità o isolati, quali spazi potessero essere esplorati, come far passare loro il tempo. Prima della Riforma Basaglia, l’infermiere doveva limitarsi ad eseguire gli ordini impartiti dal Medico e dalla Caposala. Oltre al ruolo di “guardiano”, agli infermieri competevano la cura e la pulizia di locali, arredi suppellettili. Gli spazi e l’organizzazione erano articolati in un sistema piramidale che vedeva il Direttore del Manicomio all’apice a seguire i Primari, i medici, la caposala e infine gli infermieri guardiani. I regolamenti disciplinavano tutta la vita del manicomio che veniva scandita da una serie di rituali: la chiusura delle porte e delle finestre; i conteggi delle posate, delle lenzuola, delle divise, degli internati. Tutto doveva rimanere immobile ed immutabile nel tempo, nulla doveva mancare. Nel Manicomio esisteva un sistema di progressione di carriera interno che consentiva a ciascun infermiere di ambire a diventare caposala o ispettore, ma all’epoca, lo stigma sociale marchiava pesantemente non solo i malati, ma anche chi lavorava all’interno delle mura. I malati Venivano rinchiusi in manicomio non solo individui con una diagnosi psichiatrica, ma anche chi ritenuto socialmente scomodo (da estromettere dall’eredità, non più produttivi, alcolisti) appartenenti soprattutto alle classi più deboli, svantaggiate e povere, fragili e pertanto maggiormente esposte. L’entrata in manicomio determinava una frattura con la propria storia, l’oblio dei propri affetti era uno degli scopi dell’internamento. Chi entrava era spesso destinato a restarvi per sempre; la sua identità veniva cancellata; non poteva possedere nulla; era costretto ad indossare la divisa dell’internato, uguale per tutti, spesso della taglia sbagliata. Solo ed unicamente corpi. Con l’alibi dell’ergoterapia, i malati venivano sfruttati per lo svolgimento di lavori scomodi e non qualificati (pulizie, riparazioni, …), ricompensati al massimo con qualche sigaretta e pochi centesimi; ciò consentiva anche di contenere i costi dell’istituzione. C’era uno spazio dedicato per i malati in crisi, quelli particolarmente agitati venivano “puniti”, rinchiusi nudi in uno stanziano, denominato “il camerino”. Le loro uniche relazioni, a volte anche molto difficili, con gli altri malati e con gli infermieri. La quotidianità era scandita da ritmi fissi, immodificabili: sveglia, pasti, terapie, lavoro, riposo. L’Istituzione L’istituzione manicomiale, gestita dalla Provincia e considerata una struttura all’avanguardia, era concepita strutturalmente come una città nella città: tutto quel che poteva servire si trovava al suo interno, compresa una piccola sala operatoria. Un lungo viale divideva le aree femminili da quelle maschili, in cui erano collocati i padiglioni, denominati in rapporto alle caratteristiche comportamentali dei residenti (tranquilli, agitati, sudici…), all’esterno molto belli e funzionali, all’interno sovraffollati, angusti, intralciati da arredi scarni e pesanti. Il mazzo di chiavi, molto presente in tutti i racconti, consentiva l’accesso a tutto: porte, finestre, luci, contenitori degli oggetti comuni e persino al comando per dare l’allarme in caso di emergenza. Dalle interviste emerge un’istituzione manicomiale pesante, immutabile ed inespugnabile. I trattamenti I trattamenti farmacologici erano limitati a poche molecole, alcune utilizzate ancora oggi come farmaci di primo intervento (Aloperidolo e benzodiazepine). Accanto all’isolamento e alla contenzione fisica, realizzata mediante i letti “a rete”, denominati “gabbie”, per gestire le persone in crisi acuta o per controllare allucinazioni e deliri si ricorreva a trattamenti considerati terapeutici quali l’elettro-shock, l’insulino-terapia, la vaccino-terapia e la morfina. A Trieste non si usavano “camicie di forza”, ma emergono anche testimonianze di malati legati ai termosifoni. Fase del cambiamento Il cambiamento, ma sarebbe più corretto definirlo più propriamente una rivoluzione che scardinò dalle fondamenta il sistema sanitario, non solo quello psichiatrico, è inscindibilmente legato a Franco Basaglia il quale ha saputo trasfondere apertura mentale, consapevolezza, pensiero critico alle persone che lo hanno incontrato durante la loro vita, non solo professionale. Riconoscendo l’importanza della componente infermieristica, egli ne ha promosso e favorito la partecipazione attiva, trasformandone il ruolo da “custode” e mero esecutore di compiti assegnati a co-protagonista del progetto terapeutico. Egli agì gradualmente all’interno dell’equipe, apportando progressivi cambiamenti che coinvolgevano sia i malati che gli operatori: l’avvio di assemblee condivise; l’abolizione dei simboli di potere quali, ad esempio, le divise; l’organizzazione di eventi e manifestazioni culturali e ludiche negli spazi del manicomio, … Con Basaglia, si avvia il lavoro territoriale che impone agli infermieri una profonda rivisitazione del proprio ruolo, della propria professionalità, del modo di stare dentro l’equipe e l’organizzazione. [87] Conclusioni Una maggior conoscenza degli eventi e del contributo degli infermieri all’avvio della Riforma hanno spinto il gruppo dei ricercatori a ripercorrere, con ulteriori indagini, le fasi successive anche allo scopo di delineare i possibili futuri sviluppi nell’ambito della salute mentale. Bibliography 1. 2. Bennett DH. The changing pattern of mental health care in Trieste. Int J Ment Health 1985; 14: 7-92. Dell’Acqua G, Cogliati Dezza MG. The end of the mental hospital: a review of the psychiatric experience in Trieste. Acta Psychiatr Scand 1986; 316: 45-69. [88] Viaggio nella realtà aretina: storia degli infermieri psichiatrici Stefania Francioni, Maria Jose Cosimi, Patrizia Monaco Usl sud est Toscana, Italy Introduzione Negli ultimi trenta anni l’Assistenza Infermieristica Psichiatrica (AIP) ha subito un’evoluzione. Prima della legge Basaglia l'Ospedale Psichiatrico (OP) di Arezzo era all'avanguardia per la cura e l'assistenza al malato di mente. Risulta estremamente importante conservare le tracce e le testimonianze di chi ha vissuto questo cambiamento. Obiettivo Indagare l’evoluzione dell’AIP aretina pre e post legge Basaglia. Popolazione Ex infermieri che hanno lavorato all’OP aretino e infermieri che lavorano attualmente nelle Residenze Psichiatriche. Materiali e metodi Studio condotto con metodica qualitativa (approccio fenomenologico). Si è sviluppata una griglia di intervista semi-strutturata: 13 domande aperte per gli ex infermieri dell'OP e 11 per quelli delle Residenze Psichiatriche. Risultati Dall’analisi dei dati sono emerse otto aree tematiche. Ai tempi del manicomio ai lavoratori non era richiesto alcun titolo di studio. Le prime impressioni sono state per loro abbastanza negative, soprattutto per la mancata conoscenza del malato psichiatrico. Gli operatori del DSM hanno tutti un titolo di studio infermieristico. Gli operatori dell’OP svolgevano le loro attività in modo frazionato, senza concezione del proprio ruolo. Il coinvolgimento personale era inevitabile sia all’interno del Manicomio, sia nei vari settori dell’attuale DSM. La riabilitazione psichiatrica ha avuto inizio proprio all’interno del manicomio. In passato la risoluzione di una crisi avveniva tramite mezzi di contenzione; oggi si usano particolari strategie proattive per instaurare un rapporto efficace con il paziente ed evitare la crisi. Tutti i partecipanti hanno espresso soddisfazione per lo sviluppo e il cambiamento radicale che ha avuto la loro professione; allo stesso tempo però non nascondono le difficoltà legate all’incapacità di aiutare un paziente che soffre. Conclusioni Risulta evidente l’evoluzione dell’AIP in questo ambito dal periodo del manicomio, fino all’attuale Servizio Psichiatrico. Il ricercatore ha cercato di dimostrare non solo l’evoluzione della figura infermieristica, ma la sua importanza nella conduzione del rapporto/relazione con il paziente. Bibliografia 1. E. BONIZZONI,G. GUSSONI, G. AGNELLI, R. ANTONELLI INCALZI, M. BONFANTI, F. MASTROIANNI, M. CANDELA, C. FRANCHI, S. FRASSON, A, GRECO, M. LA REGINA, R. RE, G. VESCOVO, M. CAMPANINI and the FADOI-COMPLIMED Study Group (S. LENTI, M. FELICI, A. ZUCCONE, S. FRANCIONI, M. LEONARDI, A. TUFI): “The complexity of patients hospitalized in Internal Medicine wards evaluated by FADOI-COMPLIMED score(s). A hypothetical approach” Plos One, 16 April 2018. [89] Il ritratto di Miss Nightingale nella letteratura infermieristica italiana del primo Novecento Ivana Maria Rosi1,2, Alessandra Cerra1, Roberto Milos1,2, Stefania Rancati1,2 1 Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milano, Italy; 2Università degli Studi di Milano, Italy Tra il 1900 e il primo dopoguerra, in Italia, si avvertì l’esigenza di modificare l’assistenza negli Ospedali. Esigenza determinata da diversi fattori, uno di questi fu l’evoluzione che, già nella seconda metà dell’ottocento, aveva investito la medicina attraverso le scoperte medico-scientifiche e la conseguente trasformazione degli ospedali. Tale necessità si acuì durante il primo conflitto mondiale, infatti, l’inadeguatezza del soccorso prestato ai soldati feriti e le difficoltà derivate dalla scarsità di risorse da dedicare alla cura dei malati civili, misero in moto la prima fase del processo di riforma dell’assistenza ospedaliera. La riforma passava anche attraverso una modificazione/evoluzione della figura infermieristica. Voluta dai medici, che ritenevano vanificate le loro cure da una non adeguata assistenza, ma anche dalle femministe pratiche che già dalla fine dell’ottocento e nei primissimi anni del 900 vedevano nella professione infermieristica, ma non solo, una strada di emancipazione per le donne. Il modello cui ci s’ispirò fu quello anglosassone, strutturato da Nightingale, per la competenza e il percorso formativo compiuto dalle infermiere inglesi. Obiettivo In conformità a quanto sopra accennato, ci si è posti l’obiettivo di esplorare se e come nella letteratura infermieristica italiana, diffusasi prima della riforma dell’assistenza e della formazione avvenuta nel 1925, emerge la figura di Florence Nightingale. Materiali e metodi Per raggiungere l’obiettivo è stata condotta nel 2019 una ricerca storica. Si sono consultati manuali, pubblicazioni coeve e dizionari redatti da autori italiani, stampati e divulgati tra il 1900 e 1925 in Italia, volti a formare, sviluppare e migliorare l’assistenza infermieristica. Sono stati esclusi testi e documenti tradotti da autrici inglesi o di altra lingua. I testi sono stati reperiti nel fondo personale degli autori, nelle biblioteche civiche di Milano e Firenze, presso gli archivi storici dell’Unione Femminile e della Fondazione IRCCS Ca’ Granda Ospedale Maggiore entrambi a Milano. Le fonti reperite sono state sottoposte ad analisi filologica attraverso un attento esame estrinseco e intrinseco delle stesse; sono state classificate secondo i criteri di tipologia, originalità, veridicità; infine, per l’esegesi si è costruita una griglia tematica. Risultati Le fonti narrative rinvenute consistono in: 1. sei volumi pubblicati tra il 1912 e il 1924, utilizzati per la formazione e l’esercizio degli infermieri in quegli anni (Pugliesi Giovanni, 1912; Sforza Maria e Cervati Amelia, 1916 e 1923; Ronzani Enrico, 1917 e 1924; Quarta Giacinto, 1923); 2. quattro pubblicazioni coeve date alle stampe tra il 1901 e il 1916 per il Periodico Unione Femminile, per le riviste L’Ospedale Maggiore e Nuova Antologia (Celli Anna, 1901; Ronzani Enrico, 1914; Bertolini Pietro, 1916; Meyer Camperio Sita, 1916). L’analisi dei documenti ha messo in luce che i manuali redatti da medici, di cui ricordiamo in particolare Enrico Ronzani (medico igienista, direttore prima a Firenze e poi a Milano degli Istituti Ospitalieri) o non fanno cenno a Nightingale e alla sua riforma – in particolare se editi prima del 1915 - e benché siano testi a uso degli infermieri; oppure Nightingale può essere solo intravista in filigrana attraverso alcuni richiami al modello di infermiere da lei proposto: donne, istruite e formate in Ospedale. Infatti, Ronzani nel 1917 fa riferimento al “personale d’assistenza degli infermi” inglese che è “il più istruito del mondo” e nel 1924 (alle soglie del regio decreto d’istituzione delle scuole-convitto) al fatto che la donna sia più adatta per caratteristiche innate a occuparsi della “nobile missione di assistere”. Mentre il professor Giacinto Quarta, medico e docente presso la Regia Università di Roma, nel 1923, oltre a citare le qualità che devono essere possedute dalla perfetta infermiera, indica che questa debba formarsi in ospedale “perché là soltanto e continuamente si presentano le malattie in tutte le loro varietà di decorso e di esito”. Sono sottolineati gli aspetti del modello nightingaliano più funzionali ai medici, che vedevano nella nuova infermiera il loro miglior aiuto. In modo diverso il modello di Nightingale è riportato dalle autrici di matrice infermieristica, quali Maria Sforza e Amelia Cervati, rispettivamente direttrice e caposala di una delle prime scuole per infermieri professionali milanesi la Victor de Marchi, e da Sita Meyer Camperio, pioniera delle infermiere volontarie e fondatrice dell’ospedale-scuola Principessa Jolanda sempre a Milano. Le autrici parlano di professionalità dell’infermiera, di istruzione tecnica ma non solo - è “colta” - di abilità e di principi etici - è “educata ed elevata” - e il fine del suo operato è il “maggior benessere del malato”. Ma soprattutto ciò che emerge è che hanno visto direttamente i risultati della riforma di Nightingale in Inghilterra. Hanno potuto, durante i loro viaggi, vedere all’opera le nurses, costatare loro stesse “la ben nota abilità delle nurses e i metodi per istruirle”. Il ritratto di Florence emerge però in alto rilievo, attraverso gli scritti: di Anna Celli - infermiera diplomata in Germania, moglie di Angelo Celli, noto malariologo, e socia dell’Unione femminile di Roma - che nel 1901, su richiesta dell’unionista Ersilia Majno, pubblicò un primo articolo sullo sviluppo della pratica infermieristica; dell’onorevole Pietro Bertolini, il presidente della commissione ministeriale per la riforma infermieristica, istituita nel 1918, e che già due anni prima nel 1916, in piena prima guerra mondiale, pubblica un articolo sulla riforma dell’assistenza ospitaliera; infine, dalle già citate Sforza e Cervati, che nella seconda edizione edita nel 1923 del loro vademecum per l’infermiere (un piccolo dizionario tascabile utile durante l’esercizio della professione), inseriscono un nuovo lemma [90] Nightingale, Fiorenza, dove per una pagina e mezzo descrivono la nostra protagonista (unica infermiera citata e il termine è quello maggiormente descritto). Da queste tre fonti emerge un ritratto di Miss Nightingale come “donna superiore a ogni lode” per qualità morali, per il suo “particolare amore pei malati e pei sofferenti in genere”, per “il suo ardore umanitario, la sua materna tenerezza”; per l’intelligenza e la perspicacia che le permisero “l’intuizione dei moderni problemi igienici” e l’introduzione di soluzioni ancora prima delle scoperte di Pasteur e Lister; ma, soprattutto, a “l’eroina di Crimea”, è riconosciuta la grande capacità organizzativa, “il genio organizzativo”. Genio messo in evidenza, purtroppo, dalle necessità della guerra. Sforza e Cervati descrivono quanto ha messo in essere in quegli anni per i soldati “dando a loro non solo assistenza ma anche cibi sani, biancheria pulita, e per i convalescenti biblioteche, conferenze e addirittura un ufficio di cambiali per inviare soldi ai familiari”. Miss Nightingale è “la riformatrice della moderna assistenza”, colei che ha cambiato in meglio l’assistenza ai malati, che ha trasformato in professione l’assistere. Riformatrice in patria, dove la credibilità e l’onore guadagnatasi negli anni di guerra hanno contribuito a poter “realizzare il suo sogno: la Scuola per infermiere”. Come asserisce Bertolini (1916), secondo Nightingale la riforma ha la sua chiave di volta nella figura della Matron, una donna infermiera esperta moralmente irreprensibile, competente, con capacità, oggi diremmo, di management, che sovraintende e forma le nurses che da lei dipendono sottraendole all’ancillarità medica. Miss Nightingale è la riformatrice della moderna assistenza non solo nel suo piccolo ospedale e in Inghilterra, ma, dato il riconoscimento ottenuto attraverso il lavoro delle nurses, il suo modello è esportato in altri paesi e lei è il punto di riferimento, la consulente, “l’ispiratrice, la guida, l’apostolo – da intendersi come inviato, rappresentante – della nuova riforma”. In questo ritratto più che lusinghiero, quasi un’agiografia, dal quale emerge una donna di capacità eccezionali, Bertolini, unico tra gli autori, mette anche in evidenza delle convinzioni di miss Nightingale che non furono seguite: come il fatto che “non convenisse dar loro (alle nurses) un certificato o diploma” (permettendo loro di lavorare ovunque e non solo dove formate), e che costituissero delle “libere associazioni”. Conclusioni È indubbio che dalle fonti affiori un ritratto allettante di Florence Nightingale. Si possono però notare delle differenze di profilo legate al periodo di pubblicazione delle fonti. Infatti, durante e subito dopo la Grande Guerra, la necessità della riforma dell’assistenza pone maggiormente in evidenza il lavoro svolto e il contributo dato da Nightingale, e la sua descrizione è più ampia e approfondita. Altre differenze sembrano legate alla professione dell’autore: gli autori medici, sottolineano le caratteristiche delle infermiere a loro congeniali, quali l’eccellente preparazione, il reclutamento tra donne rispettabili, e il miglioramento arrecato all’assistenza ospedaliera a seguito del loro impiego in corsia; invece, le infermiere, oltre a questo, riservano più spazio alle note biografiche, all’educazione ricevuta da Nightingale, alle capacità organizzative, agli ideali e all’aspetto etico. Sicuramente la conoscenza e l’apprezzamento della sua opera e dei suoi valori orientarono in modo decisivo il processo di riforma dell’assistenza infermieristica in Italia. Bibliografia 1. 2. 3. 4. Manzoni E. Le radici e le foglie. Seconda ed. Milano: Casa Editrice Ambrosiana; 2016. Pascucci I, Tavormina C. La professione infermieristica in Italia. Un viaggio tra storia e società dal 1800 a oggi. Milano: McGraw-Hill; 2012. Rocco G, Cipolla C, Stievano A. La storia del nursing in Italia e nel contesto internazionale. Milano: Franco Angeli; 2015. Sironi C. L’infermiere in Italia: storia di una professione. Roma: Carocci Faber editore; 2012. [91] “Per una questione di genere”. Il profilo dell’infermiere nell’Ospedale Maggiore di Milano durante la Grande Guerra. Stefania Rancati1,2, Alessandra Cerra1, Roberto Milos1,2, Paola Bosco1, Ivana Maria Rosi1,2 1 Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Italy; 2Università degli Studi di Milano, Italy Introduzione Durante il primo conflitto mondiale gli ospedali italiani all’interno del Paese, distanti dalle zone di guerra, assicurarono la cura dei malati civili con mezzi insufficienti. La carenza di personale, causata dall’arruolamento, determinò importanti trasformazioni nell’articolazione dell’attività assistenziale. Per garantire la sopravvivenza delle famiglie negli anni di guerra, in tutta Europa le donne sostituirono gli uomini nei posti di lavoro; la manodopera femminile in Italia fu attirata da settori quali l’industria bellica, tessile e dei trasporti. La professione infermieristica, all’opposto, fu ritenuta soprattutto dalle giovani troppo faticosa, pericolosa e scarsamente remunerata. Per ricoverare i soldati feriti o malati provenienti dalla linea del fuoco, dal maggio 1915 l’Ospedale Maggiore di Milano (Istituti Ospitalieri di Milano), mise a disposizione dell’autorità militare il 50% dei suoi 2000 letti, ospitando al suo interno un Ospedale Militare di Riserva (470 posti) e 2 Ospedali Territoriali della 3 Circoscrizione della Croce Rossa (450) distribuiti nei padiglioni Litta e Zonda. Durante il periodo bellico Il nosocomio milanese dovette fronteggiare la scarsità di risorse materiali e di personale. Prima del conflitto il contingente infermieristico fu composto da 217 infermieri, retribuiti lire 3.50 al giorno (diaria) operativi in chirurgia maschile, pronto soccorso, camere d’operazione, urologia, dermatologia e da 743 infermiere (573 laiche e 170 religiose) residenti in Ospedale, adibite all’assistenza dei ricoverati di medicina di entrambi i sessi, nel reparto malattie infettive, nevrologia, chirurgia femminile e il cui stipendio, alla pari delle categorie di lavoratrici coeve, fu di ¼ rispetto agli uomini. Obiettivi Descrivere i cambiamenti inerenti il profilo dell’infermiere nell’Ospedale Maggiore di Milano durante la Grande Guerra. Contribuire a tracciare l’identità professionale negli anni del conflitto. Materiali e metodi In concomitanza della ricorrenza del Centenario della Prima guerra mondiale, si è condotta una ricerca storica. Si è esaminata la documentazione sanitaria, amministrativa e i fascicoli personali di infermieri, infermiere laiche e religiose in servizio presso gli Istituti Ospitalieri di Milano negli anni 1915-1918. I materiali sono stati ritrovati nell’Archivio Storico della Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico (AOM) da aprile a maggio 2018. Le fonti primarie rinvenute, fotografate, numerate progressivamente e trascritte fedelmente, consistono in lettere olografe inviate dalle infermiere laiche alla Direzione del nosocomio, delibere e pubblicazioni coeve. Dopo l’esame estrinseco e intrinseco dei documenti si è svolta l’esegesi degli stessi attraverso una griglia tematica. Risultati Le fonti reperite testimoniano che dall’entrata in guerra, per garantire il suo funzionamento, l’Ospedale Maggiore di Milano fu obbligato a modificare l’organizzazione interna e per fronteggiare l’emergenza annullò i giorni di vacanza e di riposo a tutti i dipendenti, intensificò l’orario dei turni a causa della grave carenza di personale d’assistenza. A pochi mesi dallo scoppio delle ostilità (1915) solo 90 infermieri rimasero in corsia, 127 furono richiamati alle armi e la Direzione Ospedaliera per sostituirli, dapprima assunse avventizi, che ben presto si dimostrarono inesperti e impreparati e in seguito provò a trattenerli chiedendo al Ministro della Guerra l’esonero di quanti furono arruolati nella Milizia Territoriale. Dopo questo tentativo, che non si rivelò risolutivo, il nosocomio decise di reclutare manodopera femminile, tuttavia alla nutrita offerta d’impiego non corrispose la medesima risposta, quindi l’ospedale fu costretto a porre modifiche al Regolamento Interno in vigore (datato 1910), “abbassando l’età di assunzione delle infermiere a 17 anni invece dei 20 previsti”. Inoltre, estese alle dipendenti laiche e religiose i settori fino ad allora peculiari dei colleghi uomini, questi ultimi ritenuti più robusti e imperturbabili delle donne. Con l’approvazione del Collegio medico dei sanitari (1915) destinò “personale femminile alle divisioni maschili di chirurgia generale e alle divisioni mediche dell’Ospedale Militare di Riserva”, a condizione di “predisporre in ogni infermeria maschile l’aggregazione di un infermiere per l’assistenza intima ai malati”. La diaria delle infermiere si mantenne di 0.90 centesimi al giorno, come prima del conflitto, “poiché la donna è dotata di minore forza fisica rispetto all’uomo, è soggetta a emotività” e riguardo alla capacità produttiva il criterio numerico rispettato per le sostituzioni fu “di 4 donne al posto di 3 uomini”. Dopo un anno di guerra (1916) le infermiere laiche interpellarono con una lettera la Direzione Ospedaliera per ottenere un aumento del salario, divenuto insufficiente a causa del rincaro e del razionamento dei viveri. Sebbene nella formula di chiusura scrivessero “nella speranza di essere esaudite ” la loro richiesta motivata non fu accolta. Nell’autunno del 1917, in una missiva chirografa, 32 infermiere laiche rivendicarono a nome delle 649 colleghe, miglioramenti delle condizioni lavorative e descrissero con acribia l’aumento delle prestazioni, sottolineando come da “quando è scoppiata la guerra prestano assistenza a 1500 malati di medicina…sono distribuite nelle divisioni speciali cutanee, celtiche, forme epilettiche e tetaniche, a contatto con qualsiasi forma infettiva e gravosa” e di essere in numero insufficiente “ 4 infermiere per 40 malati”. Inoltre, scrissero di sostituire i colleghi maschi “nelle divisioni chirurgiche tanto per forme acute quanto croniche…assistono agli atti operativi e danno aiuto in tutte le medicazioni sia di forme settiche sia asettiche” e aggiunsero di essere molto affaticate “il lavoro dell’infermiera è troppo faticoso e pesante” ed espressero il timore che la loro stanchezza potesse compromettere “la pietosa missione, che vorrebbero svolgere con diligenza e intelligente amorevolezza verso gli ammalati”. La direzione ospedaliera apprezzò il lavoro svolto dalla comunità femminile e nello stesso anno (1917) dichiarò: “ si è visto durante la guerra quale prezioso contributo porti la donna all’assistenza ai malati a differenza dell’uomo” e ancora “La guerra ha valorizzato e reso più urgente l’Istituzione della Scuola”. Si propose, infatti, l’apertura all’interno del nosocomio di una Scuola professionale per Signorine infermiere, di durata biennale, rivolta a donne rispettabili e colte, che sarebbero subentrate gradualmente a tutto il personale maschile, tuttavia la questione della mancanza di risorse economiche ne rallentò l’avvio. A tale progetto aderì allora La Giunta Comunale che [92] stanziò Lire 40.000 per avviare corsi finalizzati “all’educazione professionale dell’Infermiera”. Nel frattempo giunsero notizie d’infermieri caduti sui campi di battaglia, la prosecuzione del richiamo alle armi del restante personale maschile intensificò l’attività assistenziale delle infermiere in servizio. La comunità femminile segnalò alla direzione ospedaliera in altre epistole la mancanza di riposo tra i turni, la relazione tra il deperimento della salute e il lavoro in ospedale, a differenza dei colleghi maschi e altri lavoratori del nosocomio. Nella primavera del 1918, dopo attente valutazioni, la Direzione Ospedaliera predispose per le infermiere laiche e religiose l’aumento del salario (Lire 3.30), l’incremento dell’organico (763 infermiere laiche e 207 Suore Sorveglianti), per assicurare la riduzione dei turni, l’aumento dei giorni di vacanza. La loro diligenza fu apprezzata anche attraverso encomi, infatti: “Scoppiata la guerra la Direzione, per speciali attitudini inerenti al sesso, estese al personale femminile il reparto di tentati suicidi uomini, reparti chirurgici maschili acuti, il reparto eresipelatosi, con risultati assai soddisfacenti e successivamente anche le sale operatorie delle divisioni chirurgiche e quella oftalmoiatrica”. Al personale maschile fu riservata la cura dei malati con problemi urologici e di quelli colpiti da malattie celtiche. Conclusioni Nell’Ospedale Maggiore di Milano l’assistenza durante la Grande Guerra fu affidata al personale femminile laico e religioso. Per necessità e per particolari attitudini legate al genere, le infermiere dimostrarono fortezza d’animo e autocontrollo quanto i colleghi uomini, infatti, li sostituirono nei reparti maschili e in quelli d’urgenza. Negli anni del conflitto non si rassegnarono a subire le condizioni di lavoro precarie imposte dalle miserie della guerra e rivendicarono, attraverso il loro epistolario diretto alla Direzione Ospedaliera, la parità salariale e il rispetto di alcuni diritti sul lavoro. La loro delicatezza e competenza verso gli ammalati e soldati feriti furono apprezzate dalla comunità cittadina. Con il conflitto, in Italia, s’intraprese il processo di femminilizzazione della professione, in analogia con quanto ideato da Florence Nightingale, in Inghilterra, molti anni prima. Bibliografia 1. 2. 3. 4. 5. Cosmacini G. Guerra e medicina. Dall’antichità a oggi. Ed Laterza Roma Bari. 2011 Gibelli A. La grande guerra degli italiani. 1915-1918 BUR Rizzoli grafica veneta, 2014 Rancati S, Milos R, Cerra A, Guerrieri G, Galimberti PM, Rosi IM. Le infermiere dell’Ospedale Maggiore di Milano nella Grande Guerra. Pace, diritti e dignità del lavoro. Assist Inferm Ric, 2018; 37, 3: 149-157 Rancati S, Milos R, Cerra A, Galimberti PM, Rosi IM, L’Ospedale Maggiore di Milano e le condizioni lavorative della popolazione infermieristica femminile durante la Grande Guerra. Medicina Historica, 2019, in press Rancati S, Milos R, Cerra A, Maifrini C, Galimberti PM, Rosi IM. “Sul campo dell’Onore”. Ricerca storica in memoria degli infermieri italiani caduti nella prima guerra mondiale. Prof Inferm 2018 Jul-Sep; 71 (3):131-8. [93] Le malattie professionali delle infermiere e infermieri italiani durante la Prima guerra mondiale. Stefania Rancati1,2, Roberto Milos1,2, Alessandra Cerra1, Ivana Maria Rosi1,2 1 Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Italy; 2Università degli Studi di Milano, Italy Introduzione All’inizio del secolo scorso l’Italia divenne il paese d’avanguardia nello studio delle malattie professionali, definite forme morbose provocate dal lavoro. L’attenzione dei medici, in quegli anni, non fu posta esclusivamente, sulla cura del lavoratore malato bensì sulle peculiarità del luogo di lavoro e la sua frequentazione, quale fonte di morbilità. Gli esperti individuarono cause dirette ovvero proprie del mestiere, dell’ambiente e della durata del lavoro e indirette quali l’esaurimento organico da fatica, l’insufficienza alimentare, la deficienza costituzionale del lavoratore. Poche ricerche approfondirono quali fossero le malattie professionali degli infermieri, poiché certi malanni sono stati studiati per operai e altri professionisti, sebbene nei loro memoriali le leghe sindacali infermieristiche rivendicassero l’aumento delle paghe per il rischio infettivo e il deperimento fisico determinato dal pesante lavoro in corsia. Nei Regolamenti Ospedalieri alcune norme di profilassi, quali la pulizia individuale e l’alimentazione equilibrata, sommata alla disinfezione dei materiali, garantivano ai dipendenti la sicurezza di poter frequentare un ambiente di lavoro privo di pericoli. Inoltre, l’alternanza di turni diurni e notturni dovette prevedere l’inserimento di giornate dedicate al riposo, considerato indispensabile ristoratore delle forze. Allo scoppio della prima guerra mondiale, dal maggio del 1915, nei nosocomi all’interno del Paese, cui si riservarono la cura dei malati civili e l’accoglienza dei militari provenienti dalle zone di guerra, l’inadeguatezza dei mezzi e di personale appesantì l’attività assistenziale d’infermiere e infermieri civili. L’Ospedale Maggiore di Milano (Istituti Ospitalieri di Milano) per fronteggiare le esigenze e sostituire i numerosi richiamati alle armi, ridefinì gli orari di servizio dei propri dipendenti: incrementò la durata dei turni, sospese le vacanze e i giorni di riposo. La guerra, purtroppo, perdurò molto più tempo del previsto e la popolazione affrontò la penuria di viveri, il rincaro dei prezzi, con pochi mezzi di sussistenza. Il nosocomio milanese si trovò di fronte alla scelta obbligata del razionamento: la Direzione Ospedaliera ordinò alle infermiere di diminuire la quantità di zucchero per i malati, sostituire il caffè con infuso di cicoria, (1916) ridurre il consumo di gasolio e diminuire il riscaldamento degli ambienti. Obiettivo Descrivere le malattie professionali delle infermiere e degli infermieri dell’Ospedale Maggiore di Milano durante la Prima Guerra Mondiale. Materiali e metodi Nella celebrazione del centenario della Prima Guerra Mondiale, da poco conclusosi, si sono condotte alcune ricerche volte al reperimento di fonti documentarie, inerenti il personale infermieristico maschile, femminile laico e religioso presente nell’Ospedale Maggiore di Milano (Istituti Ospitalieri) negli anni 1915-1918. I materiali inediti, rinvenuti nell’Archivio Storico della Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico (AOM) da maggio a settembre 2018, consistono in pubblicazioni coeve, lettere olografe o dattiloscritte e delibere. I documenti ritrovati sono stati esaminati e sottoposti ad analisi filologica. Per l’esegesi delle fonti si è adoperata una griglia tematica. Risultati La popolazione infermieristica dell’Ospedale Maggiore di Milano a pochi mesi dall’inizio del conflitto (agosto 1915) fu composta da 90 infermieri maschi, il numero si era ridotto drasticamente a causa dell’arruolamento, e da 573 infermiere laiche e 170 religiose. Prima del conflitto, il personale maschile fu impiegato in Padiglioni di recente costruzione che ospitarono la dermatologia, malattie celtiche, urologia, chirurgia, pronto soccorso; il personale femminile laico e religioso, invece, fu destinato al servizio nel “vecchio Ospedale” nei reparti di medicina uomini e donne, chirurgia, malattie infettive, camere d’operazione. Dall’entrata in guerra, tuttavia, le infermiere furono impiegate anche nelle medicine dell’Ospedale Militare di Riserva, cui fu assegnato il piano terreno dell’Ospedale Sforzesco. Le malattie professionali degli infermieri e infermiere in quegli anni, secondo la Direzione Medica, si differenziarono a seconda delle prestazioni compiute e delle caratteristiche dell’ambiente di lavoro frequentato. Gli infermieri uomini si ammalarono prevalentemente di nevralgie dell’ischiatico per attività di fatica grossolana come il trasporto dei malati e di forme reumatiche per il frequente passaggio tra i Padiglioni chirurgici che non sono tra loro collegati. Tra le infermiere laiche e religiose occorsero casi di bronchiti e polmoniti, a causa del lavoro in ambienti umidi e freddi poco adatti anche al ricovero dei malati, al poco riposo dopo il turno notturno, erisipela e scabbia per il contatto con malati contagiosi. Le condizioni lavorative durante il periodo bellico divennero sempre più gravose e pesanti, si riversarono sul personale femminile, l’unico disponibile, escluso dal richiamo militare e peggiorarono dopo Caporetto. In una lettera manoscritta risalente all’autunno del 1917, le infermiere laiche (649) scrissero direttamente al Presidente dell’Onorevole Consiglio il loro sconforto per il decesso di 5 compagne di lavoro, d’età inferiore ai 30 anni, avvenuto tra luglio e ottobre dello stesso anno per infezione contagiosa. Ne danno comunicazione con la stessa modalità con cui l’Ospedale ricorda gli infermieri caduti sui campi di battaglia. Preoccupate, segnalano l’aumento della morbilità e la mortalità per forme tubercolari, rispetto ai colleghi maschi e a quelle di altre classi di lavoratrici coeve. Segnalano la durata media delle assenze per malattia, che si protrae per oltre un mese, non possono curarsi perché non hanno diritto allo stipendio se malate e, soprattutto, non vengono sostituite per la mancanza di risorse. Tra le cause, affermano l’organico insufficiente rispetto al numero di ricoverati da assistere 1500 di medicina di cui 500 affetti da tubercolosi, nonché l’aumento di malati con febbri tifoidee e meningiti cerebrospinali. Evidenziano una relazione tra l’indebolimento della loro salute si sentono deboli e fiacche e il lavoro svolto in Ospedale durante il conflitto, il peso dell’assistenza è divenuto insostenibile per le loro forze, tuttavia rimarcano di essere sane e robuste all’atto dell’assunzione. Vorrebbero dimostrare la loro diligenza nell’assistere con amorevolezza gli ammalati, non sempre possibile a causa della loro stanchezza, poiché dormono poche ore dopo una notte di servizio [94] in corsia, nei tristi locali ospedalieri adibiti a dormitorio, soffocanti d’estate e gelidi d’inverno. I dati riportarti nell’epistolario trovano rispondenza nella relazione della Direzione Medica incaricata della loro sorveglianza sanitaria, infatti, nel 1917, 4 infermiere morirono di tifo, su 13 malate. Tra gli infermieri maschi, invece, non si registrarono malati e deceduti poiché non adibiti all’assistenza dei malati tifosi. Nei quattro anni di guerra 97 infermiere laiche si ammalarono di tubercolosi polmonare di cui 14 purtroppo con esiti letali, 3 infermieri maschi perirono su 16 colpiti. Per le Suore Sorveglianti il numero di malate e defunte d’infezione tubercolare fu difficile da definire, poiché se malate vengono curate nell’infermeria del loro ordine. Il nosocomio milanese attribuì spiegazioni differenti a seconda del genere degli infermieri e delle condizioni di lavoro. Per il personale femminile laico e religioso individuò: “la minore resistenza fisica delle donne rispetto agli uomini”; i luoghi poco idonei e sudici “prestano servizio in ambienti chiusi e poco igienici che influiscono sull’organismo delle infermiere”; l’intensa attività assistenziale “per il soverchio lavoro non compensato da adeguato periodo di riposo”. Per Il personale maschile presente, esonerato per 3 mesi dal Ministero della Guerra, attribuì la causa “alle loro condizioni di vita che in questo periodo vengono ad aggravarsi considerato il tempo passato da molti di essi sotto le armi”. Sulla base di questi rilievi e per rispondere alle istanze formulate dal personale femminile, nell’aprile del 1918, l’Onorevole Consiglio approvò alcuni provvedimenti, in vigore dal primo giorno del mese successivo di quell’anno. Dispose l’aumento dell’organico con l’assunzione di 107 tra infermiere laiche e Suore Sorveglianti, per assicurare il riposo decadale tra i turni, il pagamento del salario alle infermiere malate, il ricovero delle stesse in infermerie separate, la visita medica ogni due mesi per quelle affette da tubercolosi nonché l’isolamento dei malati affetti da tifo. Conclusioni Durante la prima guerra mondiale in Italia si osservò l’aumento di malattie professionali nel personale infermieristico in servizio negli Ospedali civili. Le infermiere laiche e religiose, adibite alla cura di malati in sovrannumero e ricoverati in ambienti poco adatti, costrette a turni di servizio supplementari, risultarono maggiormente esposte ad ammalarsi di malattie infettive, anche per la loro continua permanenza in ospedale. La comunità di infermiere dell’Ospedale Maggiore di Milano, istruita e preparata, richiese e ottenne dalla Direzione Ospedaliera i cambiamenti desiderati. Sebbene le difficoltà provocate dalle miserie della guerra costringessero risparmi nelle risorse, il nosocomio si adoperò per migliorare le condizioni di lavoro, per mantenere l’incolumità di infermiere e infermieri dipendenti. L’attenzione alla salute nei luoghi di lavoro e i provvedimenti adottati per proteggerla, diventarono fondamenti irrinunciabili nella formazione e nelle proposte di miglioramento dell’assistenza infermieristica nel primo dopoguerra. Bibliografia 1. 2. 3. 4. 5. Cosmacini G. Salute e medicina a Milano. Sette secoli di avanguardia. Milano: Ornitorinco edizioni 2018. Rancati S, Milos R, Cerra A, Guerrieri G, Galimberti PM, Rosi IM. Le infermiere dell’Ospedale Maggiore di Milano nella Grande Guerra. Pace, diritti e dignità del lavoro. Assist Inferm Ric 2018 Jul-Sep; 37 (3):149-157. Rancati S, Milos R, Cerra A, Maifrini C, Galimberti PM, Rosi IM. “Sul campo dell’Onore”. Ricerca storica in memoria degli infermieri italiani caduti nella prima guerra mondiale. Prof Inferm 2018 Jul-Sep; 71 (3):131-8. Rancati S, Milos R, Cerra A, Galimberti PM, Rosi IM. L’Ospedale Maggiore di Milano e le condizioni lavorative della popolazione infermieristica femminile durante la Grande Guerra, Medicina Historica, 2019, in press. Isnenghi M, Rochat G. La grande guerra 1914-1918. Bologna: il Mulino 4 ed; 2014. [95] “Carissima moglie": le lettere degli infermieri italiani prigionieri nella seconda guerra mondiale. Roberto Milos1,2, Alessandra Cerra1, Ivana Maria Rosi1,2, Stefania Rancati1,2 1 Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Italy; 2Università degli Studi di Milano, Italy Introduzione Nel 1940 l’Italia è in guerra al fianco della Germania contro Inghilterra, Francia e, più avanti, Russia e Stati Uniti d’America. Approssimativamente, dal ’40 al ’45, furono arruolati 4 milioni e mezzo di italiani. Le classi d’età interessate furono quelle dei nati tra il 1900 e il 1923 e, dalla primavera del ’43, anche la classe 1924. L’Ospedale Maggiore di Milano, oggi Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, contribuì con una parte cospicua del proprio personale maschile: tra infermieri, medici, impiegati, operai e inservienti vennero arruolati 413 dipendenti, 88 dei quali infermieri. Dal 1929 era vigente la Convenzione di Ginevra che regolava i rapporti tra paesi in caso di conflitto armato e indicava, tra le altre, come trattare i soldati nemici catturati. Nella convenzione questi ultimi vengono definiti Prisoner of War (POW) e a loro sono riconosciuti lo status e i diritti conseguenti di prigioniero militare di guerra. La Germania era tra i paesi che sottoscrissero la Convenzione. All’indomani dell’8 settembre 1943 i rapporti tra Italia e Germania mutarono notevolmente e coloro che fino al giorno prima erano alleati, da quella data si trovarono contrapposti. Secondo le stime di recenti pubblicazioni poco meno di un milione di soldati italiani furono fatti prigionieri dai tedeschi e costretti a scegliere su quale fronte schierarsi: tornare armati al loro fianco, aderendo alla Repubblica Sociale Italiana (RSI), oppure contro di loro. Gli aderenti alla RSI furono oltre 190.000 militari nella maggior parte dei casi ufficiali e gerarchi fascisti. Chi scelse di restare fedele alla Patria, complessivamente 650.000 soldati, andò incontro a un destino altamente incerto e a una condizione di prigionia totalmente anomala e creata dai tedeschi appositamente per loro, considerati traditori: furono connotati come Internati Militari Italiani (IMI), sottratti subdolamente, quindi, alla Convenzione, negati loro i diritti di POW e inviati, per lavoro coatto, ai campi di concentramento tedeschi e dei territori occupati. Secondo il regolamento interno in uso dal 1939, l’Ospedale Maggiore riconosceva ai congiunti dei suoi dipendenti arruolati il diritto a riscuotere mensilmente parte dello stipendio a patto che il dipendente lontano desse, periodicamente, prova dell’essere in vita. Questo aspetto attribuì ai rapporti epistolari un ruolo determinante e prioritario rispetto ad altri: la comunicazione alla famiglia del proprio stato di salute trascendeva la semplice rassicurazione ai propri cari in Patria. Scopo Scopo del presente lavoro è quello di descrivere le condizioni di prigionia degli infermieri reclusi durante la seconda guerra mondiale e conoscere se l’esercizio della professione ne abbia influenzato le condizioni di detenzione e la liberazione. Materiali e metodi Presso l’Archivio Storico della Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano si sono cercate sole fonti primarie originali utili al raggiungimento dello scopo. Sono stati reperiti e analizzati tutti (N. 88) i fascicoli amministrativi degli infermieri arruolati tra il 1940 e il 1945 in cerca di testimonianze di prigionia. La metodologia storica applicata ha previsto l’analisi e l’esegesi delle fonti reperite. Risultati All’interno degli 88 fascicoli analizzati sono stati presi in considerazione i fascicoli degli infermieri fatti prigionieri nel periodo oggetto di studio (N 11). 4 fascicoli contenevano comunicazioni riguardanti il periodo di prigionia. Titolari dei rispettivi fascicoli amministrativi erano 4 infermieri: 3 sottufficiali, arruolati col grado di sergente e un graduato di truppa, arruolato col grado di caporale maggiore. Un sergente, detenuto in Egitto, è risultato POW, i restanti sono IMI detenuti in Germania, Grecia, Serbia, Croazia e Slovenia. La documentazione epistolare si compone di: • • • • • • una cartolina olografa spedita da Ernesto Bargigia, POW, con data, luogo e firma leggibili; due lettere olografe di Orione Morlacchi (noto Augusto), IMI, con data e firma leggibili; quattro lettere olografe di Giuseppe Ferrario (noto Pino), IMI, con data e firma leggibili; una lettera olografa di Luigi Maderna (noto Gino), IMI, con data e firma leggibili; due lettere dattiloscritte dell’amministrazione ospedaliera richiedenti il rimpatrio degli infermieri con data e firma leggibili; una lettera dattiloscritta del Comando militare germanico di diniego a una richiesta di rimpatrio, con data e firma leggibili; In alcuni casi le comunicazioni presentano segni di censura. Con i dati presenti nei fascicoli è stato possibile ricostruire delle brevi note biografiche. La cartolina spedita da Ernesto Bargigia è una delle tipiche cartoline della Croce Rossa Internazionale. Questa istituzione, nel rispetto della Convenzione di Ginevra, si faceva garante delle comunicazioni riconoscendo completamente al POW, come in questo caso, tutti i diritti di cui era titolare come prigioniero di guerra. Lo stesso Bargigia si presenta alla moglie come prigioniero e le comunica il suo buono stato di salute. [96] Nelle lettere di Orione “Augusto” Morlacchi, il più giovane dei quattro, si riscontrano alcuni passaggi che mettono in luce la precarietà della vita da internato: egli la descrive come “una vita piena di disagi e sacrifici” ma comunica anche che “la mia salute è ottima” perché sostenuta dal pensiero della giovane moglie e del figlio Giorgio. Le lettere di Giuseppe “Pino” Ferrario sono una fonte preziosissima ai fini del presente lavoro. Nel campo di concentramento svolge l’attività di lavoro coatto come infermiere, lo si deduce dal fatto che ha libero accesso a farmaci e presidi tanto da poter inviare a casa dell’olio di vaselina per il figlio Alfredo e far confezionare e spedire a casa un pigiama per il babbo. In una delle lettere comunica alla moglie di avere rifiutato “la proposta di essere armato”, cioè di schierarsi dalla parte dei tedeschi, preferendo “andare in campo di concentramento” piuttosto che tradire la Patria. La chiusura di una delle lettere fa intendere che il controllo censorio sulle comunicazioni era presente ed efficace; scrive alla moglie Luigia: “vorrei dirti tante cose ma non posso”. Con le poche righe che Luigi “Gino” Maderna scrive alla moglie, riesce ad assolvere il compito di manifestare l’essere in vita, sostentamento della famiglia. Il pensiero della famiglia bisognosa diventa motivazione ad andare avanti nonostante la vita del campo: “2/12/1943 Sto bene: mi raccomando a te e al nostro bambino di tenervi sempre in buona salute. Perché voi siete tutta la mia vita: tuo. Gino”. Attraverso due lettere dattiloscritte, il Commissario Prefettizio e il Segretario Generale, vertici politico e amministrativo dell’Ospedale Maggiore, chiedono al comando germanico, il rimpatrio dei propri dipendenti in prigionia. La motivazione addotta nelle richieste fa riferimento all’impossibilità di sostituire gli infermieri reclusi, altamente qualificati, con personale avventizio. A una delle richieste di rimpatrio, quella per Giuseppe Ferrario, il comando tedesco risponde negativamente; a questo diniego Pino Ferrario porrà rimedio personalmente riuscendo a evadere dal campo di prigionia e unendosi ai gruppi partigiani jugoslavi fino alla fine del conflitto. In alcuni casi, pochi, la richiesta di liberazione venne accettata: non si ha una comunicazione di risposta ma a distanza di poche settimane dalla richiesta, Gino Maderna è di nuovo a Milano, libero e al lavoro. Discussione In tutte le comunicazioni la priorità è quella di rassicurare/assicurare la famiglia. Altri aspetti che emergono dagli scritti sono la volontà di prendersi cura dell’altro prescindendo da modi e tempi tipici del Lager. Attraverso la dignità del proprio lavoro, l’assistenza, gli infermieri mantengono la propria e l’altrui dignità. Restano fedeli alla Patria e si fanno carico completamente delle conseguenze di tale gesto rispondendone in primis di fronte alle proprie famiglie. L’esercizio della professione influenza la prigionia: contrariamente a quanto avveniva di consueto nei campi di lavoro coatto, qui sono gli infermieri che spediscono a casa pacchi con generi di prima necessità e farmaci. Non richiedono alimenti o vestiario alle famiglie e hanno accesso a medicamenti, farmaci e presidi. Infine, l’essere infermiere garantisce la liberazione di uno di essi; forse perché Capo Infermiere in Patria? Conclusioni Non ci sono diari, quanto rinvenuto è un epistolario privato. L’esegesi delle fonti porta a dichiarare una condizione di opposizione attiva all’abbruttimento fisico e morale tipico dei campi di concentramento in Germania e nei territori occupati. L’esercizio della professione ha influito notevolmente sugli esiti e sulle condizioni di detenzione. Come per Florence Nightingale, la guerra ha condizionato le vite dei colleghi e ancora una volta la professione salva non solo i destinatari delle cure ma anche gli autori. Bibliografia 1. 2. 3. 4. 5. Avagliano, M., & Palmieri, M. (2009). Gli internati militari italiani. Diari e lettere dai lager nazisti 1943-1945. Torino: Einaudi. Chiesa, P. (2009). Carissima Famiglia…La Croce Rossa e le lettere dei prigionieri di guerra milanesi 1940-1946. Milano: Mursia. Gaetano RM, Mlos R, Rosi IM, Rancati S. Gli infermieri italiani richiamati alle armi nella seconda guerra mondiale: l’epistolario degli anni di prigionia Prof Inferm, 2016, 69(4) 237-243. Rochat, G. (2008). Le guerre italiane 1935-1943. Dall’impero d’Etiopia alla disfatta. Torino: Einaudi 2 ed. Sabbatucci, G., & Vidotto, V. (2002). Storia Contemporanea. Il novecento, Roma –Bari: Laterza. [97] Lo Stile assistenziale degli Infermieri Fratelli di San Giovanni di Dio in Europa dal 1596 Addolorata Vassallo Polo Didattico Fatebenefratelli Università Tor Vergata, Italy Introduzione Giovanni di Dio organizzò l’assistenza dei malati e dei poveri influenzando la vita dei suoi seguaci con la forza della carità che possedeva. Non erano necessarie regole scritte per il servizio degli infermi, né per soddisfare i loro bisogni e per l’organizzazione del suo ospedale. Nei primi vent’anni successivi alla sua morte, i suoi Seguaci riuscirono a diffondere lo stile assistenziale che avevano visto praticare da Giovanni di Dio in diversi luoghi, prima in Spagna, poi in Italia e dopo in tutto il mondo. Solo in un secondo momento regolamentarono per iscritto le funzioni assistenziali degli Infermieri e possiamo ritrovare nelle Costituzioni e nei Testi scritti in seguito per la formazione dei novizi le prime indicazioni sull’organizzazione e sull’amministrazione di un Ospedale, nonché sulle funzioni infermieristiche. Obiettivo L’obiettivo del presente lavoro è l’esplorazione delle basi culturali dell’Ospitalità al fine di articolare i diversi significati sociali, culturali, economici e politici che hanno configurato la Storia dei principi innovativi dell’assistenza infermieristica messa in atto dagli stessi Fratelli Infermieri di San Giovanni di Dio. Metodo Riflessione realizzata sull’analisi dei documenti riguardanti l’Organizzazione assistenziale dei Fratelli Infermieri di San Giovanni di Dio; i Documenti consultati si trovano presso l’Archivio Generale dei Fatebenefratelli (AGF ) che ha sede a Roma Le Costituzioni sono un testo molto elaborato che mette in luce il modo di vivere dei Frati, le finalità dell’Ospedale e la sua organizzazione. Le prime Costituzioni scritte del 1587 sono un testo molto elaborato che mette in luce il modo di vivere dei Frati, le finalità dell’Ospedale e la sua organizzazione. Il testo è stato rielaborato e modernizzato nelle successive revisioni che hanno modificato solo il testo, ma i principi assistenziali sono rimasti inalterati. Il principio fondamentale più significativo è lo spirito del servizio di qualità, l’umanizzazione e il fervore tramandato da Giovanni di Dio. Nel testo è scritto con chiarezza come un Ospedale deve avere quale aspirazione basilare il dare una risposta ai bisogni degli Infermi, ponendo sempre la persona al centro dell’assistenza. Nella costruzione ed organizzazione degli ospedali, sono presenti criteri igienici, quali ad esempio la cubatura delle stanze, che debbono essere ben arieggiate, l'attenzione all'isolamento di alcuni malati, l'insistenza di occupare ogni letto con un singolo degente. Altro aspetto di cui tengono particolarmente conto i Fratelli di San Giovanni di Dio è quello legato alla convalescenza. Gli ospedali dei tempi, superata la fase acuta della malattia, dimettevano subito i malati, che essendo prevalentemente poveri, subivano ricadute spesso letali. Vennero ideati, quindi, e furono costruiti i primi convalescenziari, con l’introduzione nella prassi ospedaliera di alcuni giorni di convalescenza in ospedale. Alcuni principi: • • • • • • • • • • • • • • • • • Umanizzazione e qualità dell’assistenza Igiene della persona e cura dell’abbigliamento al momento del ricovero Registrazione dell’Infermo con raccolta dati al momento del ricovero Definizione e pianificazione delle cure Assegnazione letto, numerato, per singolo Infermo Letto provvisto di campanello e opportunamente attrezzato Presenza di sedie comode Scelta del vitto da parte dell’Infermo e assegnazione di una dieta adeguata alla patologia Presenza di personale qualificato e responsabile, diviso per funzioni Figura dell’Infermiere Maggiore, visto come potrebbe essere oggi il Dirigente infermieristico o il Coordinatore. Presenza di un libro di “memorie” con tutte le indicazioni terapeutiche per singolo Infermo. Presenza di Cartella clinica posta in una scansia della sedia comoda vicino al letto di ogni singolo infermo Organizzazione turni di servizio Norme igieniche ambientali Sala di isolamento per Infermi allo stato terminale “Guardaroba” dove conservare gli effetti personali di ogni singolo Infermo Biancheria sufficiente per cambiare giornalmente il letto [98] • Sala per gli Infermieri con materiale per l’assistenza. Presenza di una tabella con placchette di metallo corrispondente ad ogni singolo letto per individuare la chiamata dell’Infermo • Spezieria propria dell’Ospedale Nel 1741 il padre Fra Diogo de SantIago, religioso portoghese di S. Giovanni di Dio, nella “Postilla religiosa e arte per Infermieri …” spiega che il suo scritto è frutto dell’esperienza del suo lavoro e si rivolge a coloro che possono apprendere e affinare le tecniche di assistenza affermando che “ …questa Arte per gli Infermieri è una prassi moderna, che rivista e corretta dai medici preparati e chirurghi esperti, ne hanno potuto usufruire i miei novizi e religiosi della Nostra Sacra Religione, e che chiaramente mostra agli altri i suoi postilli e non solo per gli altri ma anche per se stessi, e come si verifica di curare le anime dei peccatori, così attiene a loro curare i corpi degli Infermi con l’aiuto di questo scritto.” Il suo unico desiderio è quello che i Novizi apprendano e come Religiosi perfezionino il voto di Ospitalità. L’opera è divisa in tre parti. Nella prima si tratta di argomenti religioso-morali sia per i novizi che per i professi, sudditi e superiori; nella seconda parte, si analizzano le varie infermità e vengono riportate ricette allora ritenute valide, anche se molto originali; nella terza, si descrive l’Assistenza dei moribondi. L’autore ammonisce i Novizi: “ Le aule in cui voi studiate devono essere le infermerie, dove i libri sono gli ammalati, che il Santo Giobbe, nei suoi libri, chiamava poveri Infermi” e rivolgendosi ai Superiori ricorda : “ Nelle Infermerie dovete usare la maggior carità e vigilanza possibile”. L’Autore Fra Diogo consiglia di distinguere le aree di competenza degli Infermieri e dei Medici e Chirurghi, facendo intendere che già a quel tempo si delineava un’area di competenza autonoma delle funzioni degli Infermieri. Nel testo vi sono istruzioni interessanti che già indicano le specificità dell'arte infermieristica come, ad esempio. la registrazione infermieristica, il dosaggio e l'ordine di somministrazione di medicinali e trattamenti, le procedure da osservare in caso di sanguinamento e in assenza di un intervento chirurgico o la cura da somministrare quando si soccorre un paziente, senza dimenticare le preoccupazioni etiche e il dovere di ospitalità. Le cure più appropriate basate sulla conoscenza empirica di quel tempo. D'altra parte, molte delle raccomandazioni riguardanti il rispetto e l'attenzione alla cura del paziente rimangono attuali e contribuirebbero ogni giorno all'umanizzazione dell'ospedale. La forma di queste proposte di cura suona oggi esagerata ma, in sostanza, si adattano al concetto di benessere integrale, rispetto per la persona malata e cure olistiche da promuovere per la piena salute dei pazienti. Potremmo aggiungere che un tale approccio costituisce un rifiuto pratico di tutto il riduzionismo nell'assistenza scientifica ai malati. Dall’analisi del testo di Fra Bueno y Gonzalez del 1833 “ Arte de Enfermeria para La Assistencia teorico pratica de los pobres infermo que se acogen a la de los hospitales de la sagra religion de M.P.S. Juan de Dios…” si può affermare che l’autore conosceva perfettamente la natura dell’ Infermieristica e la capacità di sviluppare ognuno dei suoi aspetti. Già nella sua introduzione chiarisce il suo obiettivo principale: “fornire agli Infermieri una maggiore conoscenza delle sue funzioni, in modo che possano fornire ai pazienti poveri un'assistenza più soddisfacente”…” L’esercizio della parte infermieristica essa debba costituire una scienza particolare, insegnata secondo principi, praticata sin dalla giovane età, e comprensiva di tutti quelli elementi che descrivono l’uomo, nella conoscenza dell’essere infermo e bisognoso di tutto l’aiuto, degli incidenti fisici e morali, che possono costituire la loro risoluzione o ritardo, e delle risorse con cui una mano destra, benefica e consolatrice, guida verso il nord sicuro dell’ osservazione della capacità che si ha nel porre rimedio”. Il suo impegno per il rigore scientifico rende questo libro un precedente importante per l'assistenza infermieristica moderna. Questo libro presenta un salto qualitativo, ma si basa anch’esso sulle Costituzioni dell’Ordine, documento base della formazione degli Infermieri Frati durante tutta le loro evoluzione. Josè Bueno tratta in maniera sistematica tutti i campi che considera preziosi per una corretta pratica dell’Infermieristica. Il suo obiettivo precipuo è che l’Ordine cresca nello sviluppo dell’ospitalità, incrementando le conoscenze specifiche dell’infermieristica per i frati infermieri al fine di migliorare l’esercizio dell’ospitalità. In questo suo ruolo di docente, strettamente unito al suo ruolo di ricercatore, dà indicazioni come deve essere impartita la formazione dei novizi da parte dei loro maestri, e tratta della relazione tra teoria scientifica e pratica e come devono essere valutati i discenti. Molto interessante la descrizione esaustiva che fa della distribuzione di una stanza di cura e le condizioni che devono essere soddisfatte sia in termini di dimensioni, disposizione delle prese d'aria e finestre (la luce e la circolazione dell’aria sono molto importanti nell’architettura ospedaliera di San Giovanni di Dio come elementi complementari dell’assistenza) o elementi di costruzione come il numero dei letti, la distanza tra essi e le loro caratteristiche (per facilitare la loro pulizia). Conclusione Nei testi analizzati è presente una lezione su ciò di cui l'Infermieristica ha bisogno per la sua corretta realizzazione e, ancor di più, un'immersione negli accorgimenti che devono accompagnarla. Sono continui i riferimenti al saper essere, a come dovrebbe lavorare un infermiere, al carisma che sin dalla fondazione fino ai nostri giorni hanno caratterizzato tutti coloro che sono stati chiamati ad esercitare l’Ospitalità all’interno dell’Ordine dei Fratelli di S. Giovanni di Dio. Bibliografia I Documenti consultati si trovano presso l’Archivio Generale dei Fatebenefratelli (AGF), che ha sede presso la Curia Generalizia sita in Roma in via della Nocetta, 263. [99] La dott.ssa Chiara Donati è stato un valido supporto nel ricostruire la Storia dell’Assistenza dei Fratelli di San Giovanni di Dio. Per semplicità verrà riportata di seguito solo la sigla AGF. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. Costituzioni della Congregazione di Giovanni di Dio Roma 1587 e successive modifiche, AGF Roma Manoscritto originale delle Regole e Costituzioni della Congregazione del devoto Giovanni di Dio - Roma 1596, AGF, Roma Ugone da S. Vittore,(1617) Regola di S. Agostino e Costituzioni della Religione di San Giovanni di Dio, Roma, Stamperia della Camera Apostolica, AGF, Roma Soriano,P.(24.06.1587) Costituzioni della Religione di Giovanni di Dio, AGF, Roma Paolo V, (1718) Costituzioni della Religione di San Giovanni di Dio, Roma, AGF, Roma Padre Trinchese G.M., (1718) Della visita Generale e Provinciale-Istruzione e Formula da osservarsi inviolabilmente in tutta la religione di San Giovanni di Dio, Roma, AGF Padre De Santiago D.( 1741), Postilla Religiosa, e Arte de Infermeiros, Lisboa Occidental, na Officina de Miguel Manescal da Costa , Impressor do Santo Officio ( Copia conservata presso l’AGF, Roma) Padre Bueno y Gonzalez,( dicembre 1833), Arte de Enfermeria para la Asistencia Teorico-Pratica de los Pobres Enfermos que se acogen a la de los Hospitales de la sagrada Religion de M.P.S.Juan de Dios, y constituye la segunda parte de la Instruccion de Novicios, Madrid, Oficina de D. Juan Nepomuceno Ruiz. – Originale, AGF, Roma Rusca E.,(1833) Manuale dell'Infermiere ossia Istruzione sul Modo di Assistere i Malati, Milano, coi Tipi di Paolo Andrea Molina Papis G.,(1844) Sulla Medicina e sugli Ospitali di Milano- Opuscolo del Dottore Giuseppe Papis Medico Onorario dello Spedale De' Fatebenefratelli, Milano, Coi Tipi di Paolo Andrea Molina, AGF, Roma Francesco Azzurri (1865) La Nuova Sala Amici nell’Ospedale dei Fatebenefratelli all’Isola Tiberina. Dallo Stabilimento Tipografico di Giuseppe, Via Corso 387, Roma. AGF , Roma. Silenzi G., (1865) La nuova Sala Amici nell'Ospedale dei Fatebenefratelli sull'Isola Tiberina. Relazione storico critica del Dr. Giovanni Silenzi, Roma. Tipografia delle belle arti AGF, Roma. Padre Meyer R.(1927) Costituzioni dell'Ordine Ospedaliero di San Giovanni di Dio detti Fatebenefratelli, Roma, Tipografia Poliglotta Vaticana- AGF, Roma. Bernardino MASCI, Doveri e Virtù dell’Infermiere, Roma, Tipografia Agostiniana, 1934 AGF, Roma. Le Costituzioni dei Fatebenefratelli del 1956 con Introduzione e note di P. Gabriele Russotto O.H. , Roma Edizioni dell’Ufficio Formazione e Studi dei Fatebenefratelli, AGF, Roma Gabriele RUSSOTTO, O.H., Scuola universitaria medico-chirurgico-farmaceutica istituita dai Fatebenefratelli in Milano nel 1849, in “Vita Ospedaliera”, 1952, A. VII, n. 1, pp. 13-17. Gabriele RUSSOTTO, O.H., Contributo dei Fatebenefratelli allo sviluppo ospedaliero, in “Atti del Primo Congresso Italiano di Storia Ospitaliera Reggio Emilia, 6-12 giugno 1956, pp. 630-637. AGF, Roma. Cecilio ESEVERRI CHAVERRI, Historia de la enfermería espanola e hispanoamericana, Barcelona, Salvat Ed., S. A., 1984. AGF, Roma. [100] Le competenze avanzate dell'infermiere in Italia e la diversa formazione professionale nel mondo: analisi dei casi in Spagna, UK e USA. Ginevra Gori Master in Infermieristica pediatrica - Firenze, Italy Nell'area assistenziale negli ultimi anni sentiamo sempre più parlare di "Competenze esperte e Competenze avanzate dell'infermiere", ma vediamo nello specifico che cosa intendiamo: quando parliamo di "Comletenze Esperte" intendiamo tutto ciò che il Professionista acquisisce durante il percorso lavorativo le "Competenze Avanzate" riguardano un proseguimento ed ampliamento delle conoscenze attraverso una formazione continua e mirata per raggiungere un determinato obiettivo. (1) A livello europeo nel 2013 L'EFN (European Federation of Nurses Association) stipula la "Direttiva sul Riconoscimento delle qualifiche Professionali" che, tramite vari articoli e punti, delinea le caratteristiche che deve possedere un Professionista per essere ritenuto Infermiere Esperto in un campo campo dell'assistenza. (2) Analizzando la situazione italiana possiamo constatare come assegnato dal Novecento e ora via sia stata una continua evoluzione della normativa che ha permesso alla figura infermieristica di acquisire l'autonomia professionale. I principali riferimenti normativi italiani sono: Dpr 225/74 "Nascita del Mansionario", DM 739/94 "nascita del Profilo Professionale dell'infermiere", DM 70/97 "nascita della figura e del Profilo Professionale dell'Infermiere Pediatrico", Legge 42/99 "Abolizione del Mansionario", DM 2 aprile 2002 passaggio da Diploma infermieristico a Laurea Triennale (si determina le classi di laurea: ciclo breve e laurea magistrale). (3) Oltre a questo dobbiamo ricordarci dell'obbligo di Formazione continua mediante percorsi universitari post base (Corsi di Perfezionamento, Master di primo livello, Laurea Magistrale, Master di secondo livello e Dottorato di ricerca); in riferimento a questo con il MIUR del 2018 sono stati introdotti 90 nuovi master per ampliare l'offerta formativa per 22 professionisti sanitari. In relazione all'offerta formativa post base italiana ho allargato l'ambito della mia ricerca alla realtà spagnola, inglese ed americana; da questo è stato possibile comparare le tre realtà per poter vedere come come ognuna offra una vasta area di master e corsi universitari post base al fine di fornire competenze avanzate. Ogni paese ha dimostrato come il Sistema Sanitario vigente incentiva la crescita professionale dell'infermiere che al termine del percorso universitario puo' applicare il miglior processo di nursing per offrire un'assistenza mirata e di qualità. Al termine della ricerca è stato possibile rilevare che il paese che incentiva di più l'infermiere è sicuramente l'America affidandogli ruoli importanti nel percorso di cura multidisciplinare; l'infermiere, che ha intrapreso un determinato percorso di formazione, può prescrivere certi tipi di farmaci e applicarli come ritiene più opportuno.(4, 5) In conclusione, sarebbe auspicabile che anche l'Italia potesse offrire ampi percorsi universitari post base incentrati sia su argomenti generali dell'assistenza (es.Master in coordinamento e master in Pediatria) ma anche su argomenti più mirati in maniera tale da poter costruire Linee guida, Protocolli e Procedure specifici e costantemente aggiornati. Analizzando poi la realtà toscana in cui è stato sperimentato l'ospedale per Intensità di cure e la centralità del paziente nel processo si cura potrebbe essere un'idea poter trovare in ogni setting operativo infermieri che abbiano acquisito competenze esperte nel proprio settore per la costruzione di percorsi assistenziali mirati e personalizzati. In Italia dovrebbero essere incentivati nuovi percorsi formativi per valorizzare e ampliare le competenze avanzate dell'infermiere. Bibliography 1. 2. 3. 4. 5. 6. Carlo Calamandrei, "L'assistenza infermieristica. Storia, teoria e metodi". Nis, 1993. Direttiva 2013/55/Ue del Parlamento Europeo e del Consiglio del 20 Novembre 2013, recante modifica alla Direttiva 2005/36/ Ce al riconoscimento delle qualifiche professionali. Leggi nazionali dell'infermieristica. http://www.fnopi.it Maria Angeles Hijano Peres, "Il cammino delle infermiere verso le professionalizzazione. Studi di storia contemporanea". N.15-3-2013 Educational Student Nurses. http://educationalstudent.org Modello IPASVI su evoluzione competenze infermieristiche [101] I primi corsi di specializzazione per le infermiere diplomate nella scuola convitto infermiere professionali Chiara Cartabia1, Stefania Rippa1, Elena Signorini1, Vincenza Aloia1, Marina Negri1, Maura Lusignani2 1 ASST GOM NIGUARDA, Italy; 2Università degli Studi di Milano, Italy Introduzione La professione infermieristica in Italia nel Novecento, ha subito moltissimi cambiamenti sia in ambito formativo che legislativo. Il R.D. n. 1880 del 1925 favorisce l’unificazione della formazione su tutto il territorio del Regno. Anche a Milano si assiste alla nascita di una scuola convitto presso gli Istituti Ospedalieri, dove il Consiglio di amministrazione con delibera datata 26 marzo 1930, decide di istituire la prima scuola convitto per infermiere presso l'Ospedale Maggiore. Alla scuola possono accedere solo le femmine, e vige la condizione della permanenza in convitto. Il corso ha durata di due anni, con un terzo anno indirizzato a chi volesse diventare capo sala.(1) La Scuola viene organizzata nel Padiglione Bosisio, dove vengono ospitate 36 allieve infermiere, sia laiche che religiose. Nel 1939, con l’edificazione dell’Ospedale Niguarda, la scuola convitto viene trasferita in questa nuova sede. La nuova struttura è in grado di accogliere oltre 150 allieve e, già all’inizio degli anni ’50, vengono istituiti dei corsi di specializzazione per infermiere diplomate che nascono, inizialmente, per rispondere alle esigenze di preparazione specifica richiesta dai reparti dell’Ospedale. Corsi fortemente voluti anche dall’allora direttrice della scuola Suor Emilia Vinante. (2) Scopo Lo scopo di questa ricerca storica è analizzare i tre corsi di specializzazione istituiti presso la Scuola Convitto Professionale per Infermiere degli istituti Ospitalieri di Milano alla fine degli anni ’40 e destinati agli infermieri professionali. Il primo corso di specializzazione in assistenza in chirurgica, un corso in assistenza in pediatrica ed un corso di specializzazione in assistenza cardiorespiratoria. Materiale e metodi È stata condotta un’analisi storica dei documenti presenti nell’archivio della Scuola Convitto per infermiere professionali di Niguarda relativi ai corsi di specializzazione. Sono stati analizzati, secondo il metodo Chabot, i regolamenti e le delibere, i programmi di insegnamento ed i verbali degli esami, valutando la validità dei documenti. Risultati Già nel 1940 la legge n. 1098 offre la possibilità agli ospedali di poter istituire dei corsi di specializzazione. Si legge, all’articolo 3: “Il ministro per l'interno, di concerto con quello per l'educazione nazionale, potrà autorizzare l'istituzione di corsi di specializzazione nei vari settori dell'assistenza infermieristica e medico-sociale, ai quali potranno accedere soltanto coloro che siano in possesso del diploma di Stato di infermiera professionale o di quello di assistente sanitaria visitatrice.” (3) La scuola convitto dell’Ospedale di Niguarda, a partire da fine anni ’40, è una delle prime ad istituire dei corsi di specializzazione per le infermiere professionali diplomate. In particolare vengono istituiti 3 corsi di specializzazione: nel 1947 in assistenza chirurgica, nel 1953 in assistenza pediatrica e nel 1967 in rianimazione cardio-respiratoria. I primi due corsi proseguono fino al 1976, quando la Regione ne dispone la cessazione, mentre quello di rianimazione prosegue anche negli anni seguenti. (4) I suddetti corsi nascono dall’esigenza riscontrata in alcuni reparti, quali le camere operatorie, i reparti di pediatria e le rianimazioni, di avere infermiere più preparate, esperte e specializzate. L’analisi svolta sui tre corsi di specializzazione tiene conto di: criteri di ammissione, durata dei corsi, programmi di insegnamento ed importanza del tirocinio e degli esami finali. Il corso in assistenza chirurgica prevedeva alcuni requisiti di accesso: l’allieva doveva presentare il diploma di infermiera professionale, il certificato di sana e robusta costituzione, il certificato penale e la ricevuta del versamento della tassa d’iscrizione (la quota di ammissione nel 1947 era fissata a 200 lire). In base a precise norme veniva stilata una graduatoria in cui venivano valutati i titoli di pratica chirurgica acquisita nei reparti ospedalieri, l’attività dell’allieva stessa, la disciplina, il contegno, le attitudini professionali, l’anzianità di servizio e la costituzione fisica. Il numero delle allieve è fissato a 15 per ogni anno scolastico. Il corso aveva una durata di 10 mesi ed era interamente sostenuto economicamente dalle allieve (nel 1947 le allieve versavano 3000 lire ogni mese come quota di frequenza). Le principali lezioni vertevano sulla patologia chirurgica, sulla tecnica e assistenza operatoria, sul funzionamento dei reparti operatori e delle sale di medicazione. Erano previsti anche degli insegnamenti di etica professionale applicati alla chirurgia. Il tirocinio era obbligatorio e veniva svolto presso i reparti operatori delle divisioni chirurgiche dell’ospedale e del padiglione di pronto soccorso. Le allieve avevano l’obbligo di fare 200 ore di tirocinio per non più di 7 ore al giorno. Al termine del corso venivano sostenute tre prove di esame: una scritta, una orale e una pratica. Per essere promosse e conseguire il certificato attestante la specializzazione in assistenza chirurgica, si doveva raggiungere una votazione di almeno 7/10 in ogni prova. Va sottolineato che solo nel febbraio del 1966 venne emanato il decreto interministeriale n. 300.16.II.49/7 che autorizzava l’amministrazione di Niguarda ad istituire il corso annuale, e di cui ne approvava ufficialmente il regolamento ed i programmi di insegnamento. (5) [102] Si possono riscontare molte affinità nel corso di specializzazione in pediatria. I requisiti di accesso erano pressoché identici al precedente corso, con l’eccezione che non veniva stilata una graduatoria per l’ammissione. Anche questo corso prevedeva un numero programmato di allieve e la durata era di 11 mesi. Erano previste 205 ore di lezioni teoriche. Tra i principali corsi spiccano, per interesse: anatomia e fisiologia, cenni di embriologia, igiene nell’età evolutiva, patologia infantile, chirurgia infantile, di prematurità e immaturità, lezioni di assistenza al bambino sano, assistenza psicologica dell’età evolutiva, assistenza affettiva e assistenza al bambino malato. Il corso di specializzazione in pediatria prevedeva l’obbligatorietà del tirocinio che era svolto presso i reparti della divisione pediatrica ed annesso reparto degli immaturi. La modalità di esame era la medesima del precedente corso di specializzazione. Anche questo corso viene ufficialmente istituito alcuni anni dopo con Decreto legge 10 maggio 1965 nel quali vengono, inoltre, approvati il regolamento del corso e i programmi di insegnamento. (6) Il corso in rianimazione cardiorespiratoria, viene istituito a Niguarda con delibera n. 765 del 1965 e con decreto del Ministero della sanità del 4/2/66. Fino al 1973 è denominato “Corso teorico e pratico di rianimazione cardiorespiratoria” dal febbraio del 1974 il nome viene modificato in “Corso Teorico Pratico di specializzazione in anestesia e rianimazione”. I requisiti di accesso sono identici ai due corsi precedenti, rimane invariato anche il numero programmato di allieve (15) e la durata del corso (11 mesi). Le allieve sostenevano interamente il costo del corso che era di lire 1500 lire al mese nel 1962. Le principali lezioni vertevano sulla fisiologia e patologia, sulla cura ed assistenza ai “rianimandi” e sulle tecniche di rianimazione, sull’assistenza ai malati in fase di risveglio. Il tirocinio veniva svolto presso i reparti di pronto soccorso, rianimazione, blocchi operatori (come aiuto anestesista) e unità coronarica. Le modalità dell’esame finale sono le stesse degli altri due corsi, ed al termine l’infermiera conseguiva un certificato di specializzazione in rianimazione cardiopolmonare. (7) Conclusioni I tre corsi di specializzazione che nascono negli anni 50 rispondono all’esigenza di avere infermiere più specializzate, con conoscenze specifiche mirate all’assistenza in reparti specialistici. Viene abbastanza immediato il paragone con l’oggi e con i percorsi post-base che vengono “offerti” all’infermiere per approfondire alcune conoscenze rispetto all’assistenza in particolari situazioni; argomento attuale all’interno della professione infermieristica. E’ stato fatto un paragone tenendo in considerazione i requisiti di accesso, la durata dei corsi, i programmi di insegnamento, l’organizzazione del tirocinio e gli esami finali. I requisiti di accesso risultano essere pressoché identici: nel passato, costituiti dal possesso del diploma che attestasse le conoscenze base, oggi dal possesso della laurea (o titolo equipollente) che attesta le conoscenze acquisite nella formazione di “base”. Dall’analisi di aspetti riguardanti la durata dei corsi, il numero programmato di studenti e le materie “specifiche” di insegnamento, sono emerse molte similitudini tra passato e presente. L’unica, importante, differenza è rappresentata dagli esami finali. Nei corsi di specializzazione era prevista una sessione di esame finale (composta da tre prove), oggi invece gli esami sono svolti in itinere e il percorso si conclude spesso con la dissertazione di una tesi. Sicuramente, i corsi di specializzazione nati agli inizi degli anni 50, possono essere considerati gli “antenati” degli attuali corsi di formazione post-base per infermieri. La formazione è un aspetto cardine nella professione infermieristica, come anche Nightingale sosteneva fermamente in “Note of nursing”: “La nostra professione di Infermiere è tale che noi retrocediamo continuamente se non ci sforziamo di divenire di giorno in giorno migliori, questo è tanto più vero quanto più vasta si fa la nostra esperienza…” Bibliografia 1. 2. 3. 4. 5. 6. 7. Archivio storico Scuola infermieri di Niguarda. Serie 1.1 Classificazione 1.1 Segnatura 1 Archivio storico Scuola infermieri di Niguarda. Serie 114 Classificazione 3 Segnatura 114 LEGGE 19 luglio 1940, n. 1098 Disciplina delle professioni sanitarie ausiliarie infermieristiche e di igiene sociale, nonché dell'arte ausiliaria di puericultrice. Archivio storico Scuola infermieri di Niguarda. Serie 2.9 Classificazione 2.9 Segnatura da 108 a 111 Archivio storico Scuola infermieri di Niguarda. Serie 2.9 Classificazione 2.9 Segnatura 108 Archivio storico Scuola infermieri di Niguarda. Serie 2.9 Classificazione 2.9 Segnatura 109 Archivio storico Scuola infermieri di Niguarda. Serie 2.9 Classificazione 2.9 Segnatura 110 [103] Concetto di cura: origine, sviluppo e attuali prospettive di applicazione infermieristica in Italia. Giulia Santambrogio2, Cecilia Malabusini1 1 ASST Grande Ospedale Metropolitano Niguarda, Italy; 2ASST Monza, Ospedale San Gerardo, Italy La storia e l’evoluzione professionale dell’assistenza infermieristica sono argomenti molto discussi e tuttora in evoluzione: in questa occasione, vorremmo proporre una riflessione sulla nostra storia professionale e quanto ne consegue oggi in relazione al concetto di avere-prendersi cura. La storia dell’assistenza, intesa in modo generico, inizia con la nascita dell’uomo. In Europa, il Cristianesimo cambiò la concezione dell’uomo nella società ed ebbe un ruolo storico importante a partire dal Rinascimento, quando ordini religiosi e congregazioni monastiche avviarono le prime forme di assistenza organizzata che portarono alla creazione di ospedali, con l’opera ad es. di Giovanni di Dio, Camillo de Lellis, Vincenzo de Paoli. Ripercorrendo la storia dell’assistenza in Italia, per quanto si possa affermare che il monopolio dell’assistenza da parte degli ordini religiosi abbia ritardato lo sviluppo dell’assistenza infermieristica sul piano professionale laico, non si può però negare che senza la loro dedizione l’assistenza organizzata non sarebbe nata. A livello internazionale, l’origine della disciplina infermieristica moderna è ricondotta a Florence Nightingale, il cui mandato nacque all’interno delle aggregazioni religiose (Figlie della Carità di Vincenzo de’ Paoli). Nightingale valorizzò l’assistenza ai malati delineando un corpo di conoscenze specifiche e diversificate da quelle mediche, con il risultato di far attribuire alla professione riconoscimento sociale ed economico. Nightingale infine concettualizzò il contesto del malato come il focus dell'assistenza infermieristica, quindi l'attenzione posta alla persona in toto come metodo per la guarigione. A partire dalle Notes on Nursing (Nightingale, 1859) la sofferenza e i processi di guarigione sono stati continuativamente il centro della riflessione e dell'attenzione dell'assistenza infermieristica (Meleis, 2012). Nightingale fu uno dei primi studiosi a impiegare metodi di misurazione dei fenomeni, documentando risultati di ricerche e fornendo analisi statistiche (Nightingale, 1859). Dalla rivoluzione scientifica fino all’ultimo secolo, l’utilizzo del metodo scientifico divenne predominante nello studio dei fenomeni e anche nell’ambito della salute/malattia. Questo cambiamento, emerso con la logica economica della salute, ha indotto frammentazione delle cure e sviluppo di specializzazioni cliniche, anche nella disciplina infermieristica. Chi seguì a Nighitingale non ebbe successo nel mantenere la differenziazione di approccio e obiettivi tra medicina e Assistenza Infermieristica. Fu così che il modello medico occupò il campo infermieristico: igiene, salute, assistenza, ambiente di cura. L’esasperazione del tecnicismo è rintracciabile in diversi momenti della storia infermieristica in Italia. Alla fine del XX secolo, con le operazioni di ristrutturazione dei servizi sanitari, è cominciata una sostituzione del personale infermieristico qualificato con operatori di supporto (Sironi, 2012). Si può dire che l’allontanamento dall’uomo in Italia emerse con l’evoluzione del processo di professionalizzazione dell’assistenza infermieristica (Sironi, 2012). Nel tempo, il metodo sperimentale di conoscenza oggettiva e riproducibile si è dimostrato insufficiente come unico approccio nell’ambito della salute-malattia. Nel 2014, l’EBM è stata dichiarata “ufficialmente in crisi” (Greeenhalg) in quanto, concentrandosi su aspetti statistici, metodologici allontanandosi dall’obiettivo, la persona. Lo stesso recente avvento delle “Medical Humanities” ne è sintomo. Quando parliamo dell’uomo ne riconosciamo due aspetti coesistenti, correlati: corporeo e incorporeo. Nella cura non è risolutivo considerare solo il corpo, come già postulato da Nightingale nell’Environmental Theory. Meleis (2012) riporta studi che evidenziano la necessità di un ampliamento di prospettiva verso scienze umane e ricerca qualitativa. Riteniamo che le domande fondamentali stimolate dall’esperienza di cura, siano fondamentali durante la carriera professionale poiché fondamentali rispetto a come l’organizzazione e le politiche sanitarie prendono forma e direzione nella nostra società (Todres et al., 2009). Lo svolgimento di questa nostra riflessione è stato stimolato dallo studio della nostra storia affiancato alla sensazione di mancanza percepita quotidianamente in Terapia Intensiva, ove le incongruenze di un’assistenza esclusivamente giocata nel campo delle scienze sperimentali sono evidenti. Si è dunque passati attraverso un lavoro di approfondimento e ricerca di una definizione di “assistere” nel senso di “avere-prendersicura”(Caring).Perriuscire a definire un concetto poco tangibile si è dovuto aprire le porte di diverse discipline. Attraverso una tesi di Laurea Magistrale, una scoping review, è stata approfondita la letteratura proveniente dagli Studi e dalle Scienze Umanistiche, in particolare: filosofia, antropologia, pedagogia, sociologia e psicologia; si è poi approfondito il tema nella Scienza Infermieristica. Il contesto in cui si è sviluppata la ricerca è quello statunitense e dell’occidente Europeo. Nei contesti di origine anglosassone, quando ci si è accorti che l’evoluzione professionale si stava via via discostando dal core della professione stessa, alcuni accademici hanno percepito la necessità di riprendere un concetto fondativo e necessario da riportare alla luce: la Care. Questa necessità è evidente nella modifica delle definizioni di Nursing date dalla ANA (American Nurses Association) nel 1981 e nel 2010 (Smith, Turkel, Wolf, 2013). Dagli anni Ottanta a oggi, successivamente allo sviluppo delle prime teorie sul Caring, il dibattito accademico in ambito anglofono ha riguardato la centralità (Leininger, 1981; Watson, 1988) o meno (Benner e Wrubel, 1986) del Caring nella disciplina. I teorici che hanno studiato il Caring, hanno incontrato difficoltà perché concetto difficile da circoscrivere (Cook , 2017). [104] In Italia, il Nursing fu importato a più riprese a partire da inizio Novecento ma non avvenne un’integrazione dell’approccio anglosassone che avrebbe dovuto, come auspicato, portare forza allo sviluppo infermieristico (Sironi, 2010). Le ragioni sono numerose: a partire dalla differenza di estrazione e formazione, passando per le differenze più generali in termini valoriali e culturali, come la forte presenza religiosa, e storico-organizzativi, come l’egemonia maschile medica sanitaria. Confrontiamo la storia concettuale italiana con la traduzione dei termini inglesi relativi all’assistenza infermieristica, poichè l’etimologia racconta la storia di una cultura. L’Italia vede la definizione di Nursing nei termini di “assistenza infermieristica”. Allo stesso modo la Care inglese, risulta tradotta nel termine aspecifico “cura”, inteso come “aver cura di”. E’ evidente che, se “care” tradotto come “aver cura” mantiene un carattere elusivo, dall’altra parte “Nursing” risulta ben tradotta dall’espressione italiana “assistenza infermieristica”, che deriva dai termini latini “adsistere” e “infirmos” (Sironi, 2010). “Adsistere” è un termine che richiama chiaramente la nostra vocazione dello “stare accanto”(ad-sisto).InfineCare,nelsensodi “aver cura di” una persona, è sovrapponibile semanticamente a “assistere” (Sironi, 2013). Troviamo in quest’ultima traduzione un legame linguisticamente forte tra quella che è la descrizione linguistica italiana di “assistenza infermieristica” e la nostra vocazione alla cura, intesa come assistenza all’uomo. Accettiamo la sfida (Cavicchi, 2010; Sironi, 2010; Meleis, 2012) e tentiamo di coniugare l’approccio delle scienze umane, studiate attraverso la scoping review, la ricerca qualitativa e la nostra formazione scientifica di base. Riprendiamo dalla review la visione della cura e dell'incontro con l'Altro di questi due autori, Heidegger (1927) e Levinas (1961), fonti prime delle teorie del Caring, che aiutano nel comprendere concettualmente i nostri habitus infermieristici di approccio all’uomo. Nel contesto italiano, a livello etico alcuni autori si sono espressi in modo molto vicino al nostro sentire infermieristico riguardo alla cura. Ad esempio, Mortari (2014) ha dato una definizione filosofica dell'essenza della cura. Per concludere, dalle riflessioni precedenti emerge che la cura ha una valenza etica, poichè comportamento inter-individuale, che comporta entrambe le facce del foglio-uomo, corporea e spirituale. Che sia intesa come attività, relazione o disposizione orientata a soddisfare i bisogni, alla cura è stato attribuito un valore morale universale. Rivolgiamoci perciò all’etica che, come l’assistenza infermieristica, è una disciplina che rivolge la sua indagine speculativa intorno al comportamento dell'uomo, si posiziona tra teoria e pratica o meglio le coniuga. EvaKittay,eticistadellacura,sostienecheha un valore universale perché la maggior parte degli individui la richiede in misura diversa in momenti diversi della loro vita, oltre l'infanzia: alcuni di noi solo durante la malattia e la vecchiaia, mentre altri più o meno continuativamente (Kittay 1999). Gli esperti di etica della cura hanno sostenuto anche che la cura è più basilare per la morale che la logica dei diritti e dei doveri, poiché in sua assenza la maggior parte dei diritti risultano inutili. La storia dell'assistenza vede quindi un'iniziale vocazione, passare attraverso un'evoluzione strettamente scientifica e giungere a un finale tentativo di reintegrazione del primigeno spirito di cura nella Caring Science della Watson (in ambito anglofono). Possiamo dire che le conoscenze accumulate circa il "caring" con decenni di studi hanno portato all’accumulo una ampissima catena di associazioni e somiglianze nel tentativo di definizione della sua essenza, che fornisce sì una base di partenza per ulteriori analisi ma soffre di aspecificità (Paley, 2001). Suggeriamo sia necessario e più proficuo un approccio diverso da quello ontologico, che si interroga alla maniera socratica su “che cos’è” la cura infermieristica. Riteniamo più appropriato l’approccio etico, riferibile invece alla domanda su “come” agisce la cura infermieristica (Boella, 2012). Infine, per non perdere lo scopo infermieristico, che deriva direttamente dalla nostra storia e che ancora tratteniamo nell’ambito clinico e formativo, suggeriamo sia necessario procedere nella ricerca e nel dibattito teorico nel campo delineato con la nostra riflessione fin qui condotta. In questo anno dell’infermiere ci viene ricordato che siamo capillarmente presenti accanto alle persone e di grande impatto per la salute dell’uomo a livello mondiale. Rivolgiamo ai presenti la domanda seguente, per stimolare un dibattito: quanto l’etica della cura propria infermieristica influenza il nostro agire professionale quotidiano? In questo facciamo la differenza, rendiamola evidente! Bibliografia 1. SIRONI, Cecilia; SANTAMBROGIO, Giulia. Assistenza infermieristica: cosa è e cosa non è nel 2018. PROFESSIONI INFERMIERISTICHE, [S.l.], v. 72, n. 1, giu. 2019. ISSN 0033 - 0205. Disponibile all'indirizzo: <http://www.profinf.net/pro3/index.php/IN/article/view/584>; data di accesso: 13 mar. 2020 [105] La cultura dell’Evidence Based Practice dalle “Notes on…” di Florence Nightingale ai moderni Journal Club: l’esperienza dell’ASST GOM Niguarda. Cecilia Malabusini, Floriana Pinto ASST Grande Ospedale Metropolitano Niguarda, Italy Background Nel 1859 Nightingale pubblicò, secondo la sua esperienza diretta, le best practice di assistenza infermieristica per migliorare gli outcome degli assistiti. “Soltanto dalla osservazione e dalla esperienza s’impara qualche principio igienico, quel positivo di cui la patologia è il negativo; e dalla osservazione e dalla esperienza soltanto si imparano i mezzi onde mantenere o ristorare un buono stato di salute” (Florence Nightingale, 1859). Con tale approccio Florence Nightingale attribuì i suoi risultati assistenziali “al debito uso dell’aria fresca, della luce, del calore, della pulizia, della tranquillità, della amministrazione della dieta, colla minima spesa di forza vitale del paziente” e finalizzando la cura dell’infermo “alla riduzione della complessione umana a tale stato che non abbia malattia, ochepossarimettersidamalattia” (Florence Nightingale,1859). La storia dell’assistenza infermieristica, come analizzata da più autori, ci insegna come l’approccio al problema della guarigione sia sempre stato la messa in atto delle migliori pratiche assistenziale, a partire dal metodo medioevale per tentativi ed errori o seguendo quanto tramandato dalla esperienze precedenti, fino al culmine dell’avvento del metodo scientifico moderno. L’Evidence Based Practice (EBP) nasce in seno al metodo scientifico (Sacket et al., 1996), ha le sue radici nei precedenti approcci alla pratica clinica e si sviluppa fino ad oggi sempre più come ricerca dell’integrazione tra l’esperienza clinica individuale, le migliori prove di efficacia disponibili e il giudizio dell'assistito. Analizzando le sue opere, è possibile affermare che F.N. abbia utilizzato nel suo tempo gran parte degli step che ora caratterizzano l’EBP (Campbell, 2017), seppure con le limitazioni del suo tempo. In un’ottica di evoluzione delle conoscenze (Ausili, Sironi, 2013), l’ultimo ventennio nel panorama italiano e l’approccio a una sempre maggiore e varia complessità assistenziale, hanno portato a una tendenza all’organizzazione e classificazione chiara del sapere infermieristico inteso come conoscenze, metodi e strumenti sviluppati e impiegati dagli infermieri per spiegare e attuare l’assistenza infermieristica; l’EBN ne è chiaramente un esempio. In tal senso, la necessità di aggiornamento continuo da parte dei professionisti e l’aumento del volume della letteratura scientifica condizionano sempre più l’utilizzo di metodi che avvicinano rapidamente i risultati della ricerca alla pratica clinica. Il Journal Club (JC), dalla metà dell’Ottocento, è uno di questi e nasce come un gruppo di professionisti che si incontrano regolarmente per una lettura critica della letteratura scientifica più recente su un argomento specifico. Il primo JC formale è testimoniato essere avvenuto nel 1875, con Sir William Osler presso la McGuill University. Ad oggi, dopo 150 anni, un efficace JC è frutto di un’attenta metodologia, come descritto in letteratura (Linzer, 1987; Milbrandt et al., 2004; Deenadaylan et al., 2008), e riscoprire il suo valore partendo dalla sua storia permette di rispondere alle sfide a cui il panorama ci pone oggi, in un’ottica di professionalità, integrazione e condivisione del sapere, pluralità di approccio e multidisciplinarietà (tutti paradigmi dell’odierna complessità). Obiettivo Migliorare l’utilizzo dei risultati della ricerca in un gruppo di infermieri di area critica dell’ASST Grande Ospedale Metropolitano Niguarda. Metodi E’ stato organizzato un JC infermieristico nel periodo di marzo-giugno 2018, con modalità individuate attraverso una literature review, storica e scientifica Gli argomenti da analizzare durante gli incontri, sono stati individuati attraverso interviste e colloqui ai partecipanti, in modo che fossero rilevanti per il gruppo coinvolto. E’ stata revisionata la letteratura scientifica per ciascun argomento e presentata alla discussione la ricerca ritenuta più rilevante. Al termine è stato compilato un questionario di apprendimento e gradimento. Risultati preliminari I questionari hanno testimoniato l’aumento della conoscenza relativa alle tematiche trattate, l’incremento delle competenze relative a confronto e traduzione contestuale dei risultati della ricerca. Infine, è stato proposto dai partecipanti di proseguire il progetto anche l’anno successivo, con nuove tematiche e la scrittura di istruzioni operative condivise. Conclusioni Questa esperienza suggerisce che, anche in TI attraverso la partecipazione al JC, gli infermieri hanno sviluppato non solo la conoscenza dei migliori risultati della ricerca, ma anche le competenze per tradurla nel contesto operativo. Si è appena conclusa l’edizione 2019 del JC e la redazione delle prime Istruzioni Operative. Tale progetto conferma la lettura trasversale della storia delle scienze infermieristiche in Italia, in cui i vari approcci possono costituire numerosi spunti per analizzare i contesti professionali e per interpretare la direzione dei repentini cambiamenti o regressioni che stanno coinvolgendo il sistema e le professioni sanitarie. In tal caso l’approccio è quello dell’EBP, che possedendo radici storiche lontane, insegna e prepara gli infermieri di oggi come assistere i pazienti per il futuro, con solide basi scientifiche. Infine, l’esperienza vissuta suggerisce l’utilità di indagare la necessità di un infermiere di riferimento per unità operativa che mantenga costantemente attivo il contatto tra ricerca e pratica clinica. [106] Bibliografia // [107] L’organizzazione sanitaria dell’Esercito romano e il personale legionario non medico dedicato all’assistenza. Giancarlo Celeri Bellotti ASST Santi Paolo e Carlo, presidio ospedaliero San Paolo, Milano, Italy La massima vastità e grandezza di Roma e del suo impero, con la conseguente penetrazione della sua cultura e delle sue leggi, furono raggiunte agli inizi del II sec. d.C., sostanzialmente nel 117 con la morte di Traiano, che lasciò un impero alla sua massima espansione geografica, il quale ricopriva un’area di circa 6,5 mln. di km2. Tale potenza economica, sociale, culturale e giuridica fu favorita, mantenuta e garantita, non solo da una ben strutturata ed organizzata forma di governo, in particolar modo quello relativo alla nascita, apogeo e declino dell’età imperiale, ma anche perché l’apparato militare ne assicurava, da un lato, l’espansione, dall’altro, il controllo interno, prevenendo inoltre attacchi ed ingerenze dall’esterno. Com’è noto questo apparato militare era progettato e impostato in configurazione di Legioni, istituite già parecchio tempo prima del periodo imperiale. Dal punto di vista linguistico, Legione deriva dal latino legione(m), propriamente “raccolta/raccogliere alle armi”, derivato di legere “raccogliere” (De Mauro, Mancini. 2000), a sua volta proveniente dal sanscrito lag, lagati, cioè “aderire, avere un legame con, seguire” (Rendich, 2010). Sebbene la Legione costituisse solo una sub unità di tutto l’apparato militare generale, nel tempo il termine Legione divenne sinonimo di Esercito ed anche di leva militare. Al suo interno svolgevano i loro compiti appunto i Legionari, soldati che non erano solo e puramente dei combattenti, ma erano anche destinati a servizi di lavoro e logistica. Tra le varie sezioni che componevano i reparti, in forma di vere e proprie “specialità”, vi era anche il corpo sanitario, molto ben strutturato, organizzato e preparato, fino a comprendere, addirittura, le navi ospedale. Dunque, questa complessa struttura sanitaria militare interveniva sia durante le fasi cruente e drammatiche di una battaglia, sia all’interno di veri e propri ospedali militari, i Valetudinari, che sorsero su tutto il territorio dell’impero e, particolarmente, nel periodo di tempo sopraccitato. L’esercito aveva un forte interesse a mantenere e curare la salute dei propri uomini, e, per significare tale attenzione, molte documentazioni di quel tempo ci riportano il sollecito avvertimento che frequentemente veniva rivolto agli alti ufficiali in comando, affinché vigilassero e garantissero, ad esempio, una buona alimentazione, igiene, salute e cure indirizzate ai soldati, i quali si sarebbero sentiti così anche più protetti, aumentandone altresì la loro fideizzazione. Ne è un esempio questa frase tratta da “Epitoma rei militaris” di Vegezio: “In caso di malattie è necessario che i Comandanti, i Tribuni e chi ha la più alta responsabilità provvedano con grande attenzione a nutrire i propri uomini con cibi adatti, a curarli con l’abilità dei medici, perché non c’è nulla di peggio di quando incombono contemporaneamente le necessità della guerra e i sintomi della malattia.” La figura principale di riferimento di questa branca dell’esercito era logicamente il medicus castrensis, ovvero il primo medico dell’accampamento ed anch’esso inquadrato come Legionario, che comandava e dirigeva tutti i suoi collaboratori subalterni, medici e non. Tra le figure dedicate alla cura ed assistenza dei soldati feriti o malati troviamo dei Legionari non medici inseriti nel corpo sanitario, potremmo definirli infermieri militari specializzati in diversificate mansioni, compreso quello dell’addestramento ed istruzione delle reclute destinate poi a tali attività di soccorso ed assistenza. Scopo della presente relazione è quindi di descrivere, in sintesi, le salienze di tale apparato, nel quale emerge anche l’opera di questi Infermieri Legionari. Bibliografia Campanini-Carboni (2001). NOMEN. VOCABOLARIO LATINO ITALIANO – ITALIANO LATINO. Paravia, Milano. Cascarino G. (2010). L’ESERCITO ROMANO. ARMAMENTO E ORGANIZZAZIONE. VOL.II: DA AUGUSTO AI SEVERI. Il Cerchio Editore, Rimini. Celeri Bellotti G., Destrebecq A.L. (2013). STORIA DELL’ASSISTENZA E DELL’ASSISTENZA INFERMIERISTICA IN OCCIDENTE. DALLA PREISTORIA ALL’ETA’ MODERNA. Piccin, Padova. De Mauro T., Mancini M. a cura di (2000). GARZANTI-DIZIONARIO ETIMOLOGICO DELLA LINGUA ITALIANA. UTET Editore sez. Garzanti Linguistica. Donahue M.P. (1991). NURSING. STORIA ILLUSTRATA DELL’ASSISTENZA INFERMIERISTICA. Antonio Delfino Editore, Roma Geraci G., Morcone A. (2002). STORIA ROMANA. Le Monnier, Firenze. Goldsworthy A. (2005). STORIA COMPLETA DELL’ESERCITO ROMANO. Logos, Modena. Nizzoli Volontè M.T. (1993). GLI OSPEDALI DELLE LEGIONI ROMANE (I VALETUDINARI). Edizione fuori commercio a cura dell’Azienda Farmaceutica Guidotti S.p.A., Pisa Penso G. (2002). LA MEDICINA ROMANA. L’ARTE DI AESCULAPIO NELL’ANTICA ROMA. Collana di Storia della Medicina e di Cultura medica, diretta da. Dott. Luigi Sterpellone. Edizioni EsseBiEmme, Noceto (Pr) Peterson D. (1992). FOTOGRAFARE LA STORIA. I LEGIONARI ROMANI NELLE FOTORICOSTRUZIONI. Ermanno Albertelli Editore, Parma. Rendich F. (2010). DIZIONARIO ETIMOLOGICO COMPARATO DELLE LINGUE INDOEUROPEE. Palombi Editore. Roma. [108] La paginetta rosa dell'allieva Infermiera Antonella Franceschetti, Anna Maria Parini ASST Fatebenefratelli Sacco - Milano, Italy Obiettivo Descrivere le caratteristiche fisiche e morali, le qualità e le abilità richieste alle Allieve Infermiere delle Scuole Convitto, nel periodo 1935 -1943, attraverso l’analisi de La paginetta rosa dell’Allieva Infermiera, rubrica inserita nella rivista di categoria dell’epoca, “L’infermiera Italiana”. La rivista, edita dal 1935 al 1943, aveva lo scopo di divulgare le novità in ambito clinico e i trattamenti terapeutici delle patologie più frequenti all’epoca. Erano inoltre riportati racconti di episodi vissuti in corsia, avvisi per la partecipazione a concorsi pubblici e borse di studio, attività sindacali, nonché la pubblicizzazione di “giornate di preghiera e studio” e il racconto delle sante che avevano fatto la storia dell’assistenza. La rivista conteneva anche una rubrica dedicata alle allieve infermiere denominata “La paginetta rosa dell’allieva infermiera”. Le autrici di tale rubrica erano infermiere diplomate oppure le allieve stesse che raccontavano le loro prime esperienze in corsia. Nel 1939 la rivista cambia veste grafica e anche la rubrica cambia nome intitolandosi “Le nostre colleghe di domani”. Materiali e metodi Ricerca di fonti bibliografiche presso Archivi Storici. Riviste originali dell’epoca (collezione privata). Risultati Dall’analisi degli articoli è emersa la forte spinta a rendere la donna fulcro dell’assistenza. È la donna, infatti, che si deve prendere cura dei bisognosi per le attitudini morali che le sono proprie; il medico vuole avere in corsia una figura capace di essere una continuazione del proprio sé, il braccio destro che arrivi là dove egli, per diversità e di ruolo e di attitudini naturali proprie del “gentil sesso”, non può arrivare. La donna infermiera deve essere rappresentazione dell’ospedale che in questo momento storico subisce un profondo mutamento: da luogo in cui morire diventa luogo di cura, e anzi più propriamente “centro di perfezionamento igienico, sanitario e morale di cura.” L’infermiera è pilastro di questo nuova edificazione e suggerisce all’intera popolazione una nuova idea di igiene che si esplica sia sul piano fisico e sia sul piano morale. Rosanna Fambri, direttrice della rivista, ricordando un carcerato che aveva trascorso un lungo periodo in ospedale e che aveva subito la benevola influenza delle sue curanti, dice: “io penso che l’ambiente ospedaliero gli desse l’impressione una volta tanto di essere anche lui come tutti gli altri. Di aver acquistato moralmente un certo valore”. Si delinea quindi in questo momento storico una nuova faccia dell’infermiera, quella di educatrice che “agisce diversamente se appena essa ricorda che il suo non è solo compito di assistenza ma anche di educazione”. Se da un lato troviamo il prototipo della professionista impegnata in un lavoro che nobilita sé stessa e chi riceve le sue cure, dall’altro emerge la donna angelicata che liberandosi da ogni spinta sessuale si avvicina al “proprio malatino” e se ne prende cura “come una mamma, senza nessuna intimità”. Un elemento decisivo per il raggiungimento di questo obiettivo è la divisa, infatti: “sotto la bianca veste deve sparire ogni vanità, deve arrestarsi ogni sciocca gara di civetteria.” Uniforme che contraddistingue e che deve essere indossata sempre con “quel volto sorridente, quel passo svelto ed elastico, quella voce gaia, quasi infantile che rallegra”. Diretta conseguenza è che “anche i più gravi si sentono sollevati un poco quando chi li assiste non ha una faccia da funerale. Incosciamente pensano che, forse, non stanno poi tanto male se l’infermiera non mostra alcuna preoccupazione, e si allietano del suo sorriso e della sua tranquillità.” Altre doti e capacità richieste alle infermiere strutturate nelle scuole convitto sono: puntualità in servizio; intelligente colpo d’occhio per cogliere ogni dettaglio del proprio assistito; lealtà verso i superiori e le colleghe; una particolare attenzione nell’attuazione di interventi per la prevenzione di malattie infettive; divenire delle sacerdotesse dell’ordine, della pulizia e dell’eleganza; rispettare e ubbidire i superiori; mostrare fratellanza e spirito di corpo con le colleghe; orgoglio di essere infermiere professionali a cui questo titolo viene riconosciuto anche mediante una retribuzione per il lavoro svolto. Seppur vacante il posto del codice deontologico in questi anni iniziano a codificarsi i primi dettami che le nuove infermiere devono porsi come segna passi verso una nuova professione: l’articolo “l’ammalato non deve essere che un malato per l’infermiera, qualunque sia la sua fede politica, qualunque sia la sua moralità” recita: “dentro l’ospedale il malato non è più né fascista, né comunista, né ebreo, né cristiano, né uomo onesto, né delinquente. Come non ha sesso, non ha nemmeno personalità morale: è una creatura che soffre e che ha bisogno di noi”. Inoltre le giovani fanciulle proveniente dalle classi più abbienti della società devono riconoscere anche nell’uomo più umile e povero il “volto di Dio” e farsi carico della sua assistenza. Sempre continuando sulla scia dei principi da seguire, in altri articoli si cita l’importanza del “segreto professionale” e, cavalcando un tema quanto mai attuale, si sottolinea importanza di informare il proprio assistito per averne consenso e cooperazione, così come le parole dell’infermiera A.M. Ugazio ricordano: “bisogna abituare l’infermiera, a saper spiegare al malato tutte quelle pratiche che sia lei, sia il medico, hanno il compito di eseguire per la cura e l’assistenza del malato stesso” per ottenerne la “cooperazione”. L’infermiera in questo periodo storico è dipinta come “un soldato nel campo di battaglia” che deve rispettare il suo posto e quindi la gerarchia verso i propri superiori; in particolare rispetto ai medici, tale gerarchia si coniuga in un’obbedienza per gli ordini ricevuti, che però necessita di essere sempre applicata con intelligenza al fine di diventare “una vera collaboratrice del medico”. La Fambri citando un episodio che la vede direttamente coinvolta durante un periodo di servizio in un ospedale londinese racconta di aver salvato la vita ad un paziente somministrando, in assenza del medico, una terapia non prescritta. Con questo aneddoto vuole rimarcare l’importanza di mettere a servizio del proprio assistito le conoscenze acquisite durante il percorso di studio e il pensiero critico che contraddistinguono una buona infermiera da una mera esecutrice di ordini. [109] Conclusioni Benché le politiche del regime fossero state finalizzate ad incoraggiare l’adesione alla professione infermieristica, di fatto, tra le giovani donne non si realizzò l’interesse auspicato. Ciò probabilmente a causa delle condizioni di lavoro che richiedevano un impegno fisico gravoso e costante. Inoltre, tra la popolazione era ancora diffusa l’opinione che il lavoro di infermiera fosse di scarso prestigio sociale e destinato, pertanto, alle classi socialmente inferiori. A queste motivazioni si aggiunge il problema della retribuzione: nel corso del secolo precedente, con la nascita di diversi enti benefici, tra i quali la CRI, le donne si dedicavano, in forma cosiddetta “caritatevole”, ossia senza percepire uno stipendio, alla cura e all’assistenza dei malati. Un altro aspetto interessante emerso riguarda la visione che il regime ebbe della figura femminile: da una parte la donna venne esclusa dal mondo lavorativo e relegata nel ruolo di moglie e madre, dall’altro, nel caso dell’infermiera diplomata, il regime assunse un atteggiamento totalmente opposto, obbligando gli uomini dedicati all’assistenza ospedaliera a lasciare il posto a donne tecnicamente preparate e dedite alla loro missione. Ultimo elemento, non trascurabile, è connesso all’importanza della riforma del 1925 che istituì le scuole convitto e determinò la nascita dell’identità professionale. La formazione impartita in tali scuole, oltre a veicolare le idee del regime, contribuì a costruire un corpus di conoscenze specifico dell’infermieristica sottolineando l’importanza degli aspetti etici nell’assistenza al malato, anche in assenza di un codice deontologico. Bibliografia 1. 2. 3. 4. 5. De Grazia V. Le donne del regime fascista, Marsilio, Venezia, 2005. Rocco G., Cipolla C., Stievano A. La storia del nursing in Italia e nel contesto internazionale, Franco Angeli, Milano, 2015. L’infermiera Italiana,1935-1943. R.D. 21/11/1929 n.2330 Approvazione del regolamento per l’esecuzione del R.D. 15/08/1925 n. 1832 riguardante le scuole convitto professionali per infermiere e le scuole specializzate di medicina, pubblica igiene ed assistenza sociale per assistenti sanitarie visitatrici. Manzoni E., Lusignani M., Mazzoleni B. Storia e filosofia dell’assistenza infermieristica. CEA Casa Editrice Ambrosiana, Milano, 2019. Archivio Storico della Scuola Infermieri dell’ospedale Niguarda. [110] Suore dell’Ordine di Maria Bambina Istituti Ospedalieri di Santa Corona in Pietra Ligure (Savona) Infermiere nella guerra con la partecipazione alla Resistenza Marisa Siccardi Istituto storico della resistenza dell'età contemporanea, Italy Il complesso ospedaliero degli Istituti di Santa Corona in Pietra Ligure era in attività sino dal 1923, con difficoltà gestionali iniziali e, soprattutto, con una scarsa efficienza operativa anche infermieristica. Per tali motivi nel 1929 fu sciolto il Consiglio di Amministrazione e l’Ente fu commissariato. Constatato il degrado del complesso sanitario, si giunse alla determinazione di affidare ad un “Corpo di Religiose Ospedaliere” la direzione complessiva dei reparti e dei servizi ospedalieri, identificando nell’Ordine delle Suore di Carità fondato da Bartolomea Capitanio e Vincenza Gerosa, già attivo in ospedali lombardi, quello più idoneo a risollevare le sorti del Santa Corona. Nel 1926, per lo stesso motivo, furono già avviati contatti con la Madre Generale, ma il Consiglio dell’Ordine fu costretto al rifiuto, per l’insufficienza numerica di suore idonee allo svolgimento del lavoro richiesto. Le insistenze successive, sia da parte del Podestà di Milano, duca Visconte di Modrone e l’intervento personale del Cardinale di Milano Ildefonso Schuster, indussero la Provinciale di Milano e la Superiora di Garbagnate delle Suore di Maria Bambina a recarsi a Pietra Ligure per valutare le effettive necessità. Il risanamento dell’Ospedale, date le condizioni di notevole degrado, richiedeva l’ottemperanza a “regole” di ordine generale e logistico che avrebbero, indubbiamente, provocato ostacoli interni. Ma le Suore furono irremovibili e nel 1932 fu stipulata la “Convenzione” tra l’Associazione delle Suore di Carità e il Pio Istituto di Santa Corona di Milano, firmatari: la Superiora Generale Suor Maria Antonietta Sterni e il Presidente dell’Ente Comm. Avv. Carlo Vavassi Pecori. Mentre l’Ospedale di Santa Corona si trasformava ampliandosi sia dal punto di vista logistico, sia nell’ambito diagnostico e terapeutico medico e chirurgico, lo sviluppo dell’attività delle suore di Maria Bambina s’intrecciava con quello storico e politico del paese. Nel 1934, documenti conservati nell’Archivio di Stato di Savona mostrano inequivocabilmente l’attività del Governo fascista volta principalmente a identificare, con una ricerca scrupolosa e segreta del Ministero dell’interno, le persone che “non sono di religione cattolica”: ben quattro anni prima dell’emanazione delle leggi razziali . Nel 1938, fu pubblicato il Manifesto degli scienziati razzisti (14 Luglio) e pochi giorni dopo l’Ufficio Demografico Centrale fu trasformato in Direzione Generale per la demografia e la razza: una sezione del Ministero dell’Interno, che il 22 Agosto dello stesso anno dispose il censimento di tutte le persone definite di “razza ebraica”, anche se con un solo genitore ebreo e praticanti la religione cattolica. In questo periodo non sembra che le suore prestassero particolare attenzione a tali provvedimenti, né sembra che, con l’emanazione del Regio Decreto legge 17 Novembre 1938, n. 1728, venissero segnalati malati ebrei presso il Santa Corona, pur se documenti coevi (ASS) precisano che gli ebrei che si trovino “in ospedali , orfanatrofi e caserme” non debbano essere censiti in tali luoghi ma “nelle loro abitazioni” . La storia e l’attività delle suore di Maria Bambina inizia ad assumere un ruolo cruciale con la dichiarazione della guerra alla Gran Bretagna e alla Francia da parte di Mussolini. L’Ospedale di Santa Corona viene trasformato in ospedale militare, offrendo cinquecento posti-letto alla direzione di sanità di Genova: dal 1940 al 1944 furono ricoverate 3.313 persone, soprattutto reduci militari provenienti dai vari fronti disastrosi: Libia, Francia, Albania, Grecia, Russia ... Mentre i quotidiani e la radio vantano conquiste, i militari ricoverati, soprattutto nelle ore notturne, narrano una storia diversa. La patologia prevalente era costituita da congelamenti, infezioni tubercolari dei vari organi e apparati, ferite profonde, fratture gravi e anche paraplegie: le suore e gli infermieri e le infermiere laiche si presero cura con umanità e professionalità, attente anche all’igiene completa quotidiana e alla prevenzione delle infezioni, di persone, quasi tutte giovani, che la guerra aveva strappato alla vita regolare, spesso trasformandola dolorosamente per il resto dell’esistenza. Le amputazioni erano frequenti e l’officina meccanica, con una équipe operaia e tecnica altamente motivata, si specializzò sempre di più nella produzione di protesi di alta funzionalità ed efficacia. La storia delle Suore di Maria Bambina a Santa Corona in Pietra Ligure diventa centrale nel periodo bellico 1940-1945, perché le vicende generali e politiche, all’interno dello stesso territorio ospedaliero, con postazioni ed esercitazioni di contraerea tedesca al di sopra dell’ospedale stesso, allarmi e bombardamenti degli alleati, particolarmente cruenti nell’estate 1944 in tutta la provincia savonese (gli Alleati fecero supporre uno sbarco imminente che avvenne invece in Provenza), ne resero più pressante il lavoro e l’organizzazione. La guerra comportò anche il razionamento dei generi di prima necessità e, spesso, la loro totale mancanza. Oltre ai generi alimentari, il sale e il sapone, per tutta la durata del periodo bellico, costituirono ovunque un grave problema. La collaborazione delle suore con gli operai portò al prelievo dell’acqua di mare nei pressi della battigia della spiaggia dell’istituto prospiciente allo stesso, che veniva riversata i ampi e sottili recipienti sul tetto dell’officina e quella del sapone, mescolando nelle cantine della macelleria i residui dei grassi di cucina con la soda caustica, versandolo poi in appositi contenitori di terracotta sul tetto della cucina per farlo asciugare. Intanto all’interno dell’ospedale, per opera dell’economo, di alcuni medici e infermieri, nel mese di Maggio 1944 si era costituito un gruppo clandestino del CLN (Comitato di Liberazione Nazionale), iniziando un lavoro capillare di coinvolgimento politico del personale e dal quale prese l’avvio l’organizzazione della SAP interna (Squadra di Azione Patriottica) di supporto a coloro, tra i quali medici e infermieri, che erano già saliti sui monti. Con l’approvazione della Superiora, suor Vincenza De Paolis, alcune suore, a rischio della vita, cominciarono a collaborare, prima con aiuti alimentari, di vestiario e supporti sanitari, poi soprattutto con il Pronto Soccorso, dove la Caposala: suor Arduina, ogni volta che perveniva un partigiano, non lo registrava e lo faceva trasportare subito al padiglione 22, definito ”il covo “, dove sino alla Liberazione vennero curati a decine. Suor Artemisia, Caposala della sala operatoria, ne costituì una clandestina in un sotterraneo di collegamento dei due maggiori padiglioni: !7 e !8, di norma deputato al passaggio di tubi vari. Altre suore si alternavano in loro aiuto: suor Teodolinda Capelli (poi mia Caposala alla Scuola), suor Silvestra, suor Giovannina, suor Scolastica, Elvisa ... e le infermiere Rebagnati e Ferrari e altre/i. [111] L’impegno si intensificò, con rischio maggiore, quando una ragazza ebrea di 16 anni, Sara Dana, che (non si conosce attraverso quale prassi fosse ricoverata regolarmente), affetta da malattia intestinale, fu prelevata dal suo reparto da due ufficiali delle “SS” e da un ufficiale fascista senza più ritorno. Attraverso il CDEC (Centro Documentazione Ebraica Contemporanea) è giunta la conferma della morte ad Auschwitz. Come scrisse Amedeo Salvaterra (già Economo dell’Ospedale di Santa Corona e membro del CLN): “Questo episodio fu come una frustata per quanti - suore, infermieri, sanitari – avevano ancora vivo il senso di umanità e della giustizia e li spronò, oltre l’indignazione, ad operare con coraggio nelle file della Resistenza”. La loro opera di collegamento e di collaborazione con le forze della Resistenza fu così importante che al termine del conflitto e raggiunta la Liberazione dell’Italia dal nemico invasore, la Superiora delle suore di Maria Bambina di Santa Corona, suor Vincenza De Paolis, fu insignita di Cavaliere al Merito della Repubblica e medaglie d’oro e d’argento alle altre suore per il loro rischiosissimo, insostituibile sostegno e assistenza infermieristica che prodigarono comunque ad ogni persona malata o ferita di ogni parte... E un attestato di benemerenza fu assegnato dal CLN a tutto il personale dell’0spedale di Santa Corona perché, senza un generale sostegno collettivo, quanto sopra non sarebbe stato possibile. A suor Artemisia, A Suor Arduina e alle altre suore Resistenti, fu soprattutto di conforto e di grande soddisfazione, molto più delle medaglie, il costante ricordo dei partigiani, continuato per anni, anche quando, molto anziane, si ritirano nella Casa di Milano. A Santa Corona alle suore di Maria Bambina, dopo la Liberazione e la fine della guerra, si presentarono altre nuove sfide: la guerra, oltre alle tragedie dei bombardamenti e della fame, tra le malattie storiche e gravi aveva aggiunto epidemie di tifo e la poliomielite. Molti bambini e bambine colpite dalla polio, alcuni adulti, furono accolti e iniziata per loro la riabilitazione: negli anni Cinquanta del Novecento pressoché esclusivamente manuale. Negli stessi anni, per l’aumento di malattie infettive favorite dalle condizioni di malnutrizione, veniva effettuata la costruzione del padiglione Isolamento, denominato all’inizio “Centro profilattico” , che ospitò bambini provenienti in prevalenza dalla Lombardia. La costruzione di un nuovo grande padiglione, denominato “Chirurgico”, coincise con l’apertura della Scuola per Infermieri Professionali, diretta da suor Angela Gualla e, assieme al Centro Profilattico, divenne il “Padiglione scuola”, con le suore di Maria Bambina che ne gestivano i reparti in accordo con la direttrice nel fare acquisire capacità, competenza e responsabilità professionale a tutte le giovani allieve, al fine di trasmettere loro il “testimone” del prendersi cura. Bibliografia 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. AA.VV. (a cura ISRL e Comune di Genova), Antifascismo e Resistenza in Liguria, Atti Convegno 18-19 Ottobre 1975, Degli Orifici ed., Genova 1976. AA.VV. (a cura ISRL e Consiglio regionale Liguria), La Resistenza in Liguria e gli Alleati, Atti Convegno di studi 1983, Ed. Giuseppe Chiappini, Genova 1985. AA.VV., 1938-2018, 80° dell’emanazione delle Leggi razziali. Testimonianze, saggi, riflessioni. Numero speciale di “StoriaMemoria”, ILSREC Raimondo Ricci, Genova, 2019. AA.VV., Atti del Convegno Italia-Francia sulla Resistenza nelle Alpi Marittime, Ventimiglia 9-10 Dicembre 1995, Isrec Liguria, 1996. AA.VV., I campi di concentramento in Liguria, Circolo Brandale, Savona 2010. Aiolfi R. – De Marco N., Bombe su Savona. Fotocronaca dei bombardamenti sulla città e la provincia nella guerra 194°-1945., Marco Sabatelli ed., Savona 1995. Alfonso D., Ci chiamavano libertà: Partigiane e resistenti in Liguria 1943-1945. La parola ridata alle donne, De Ferrari, Genova, 2015. Alfonso D., Fischia il vento. Felice Cascione “U Megu”, Castelvecchi, 2015. ANPI, Documenti del CLN per la Liguria, Fabris, Genova 1947. Badarello R. – De Vincenzi E., Savona insorge, Sabatelli, Savona 1968. Borgna P. – Maneschi A. – Paggi M.L., Carte della persecuzione 1938-’45. L’applicazione delle Leggi razziali a Savona, Marco Sabatelli ed., Savona 2005. Brizzolari C., Un archivio della Resistenza in Liguria, Di Stefano ed., Genova 1978. Burzio G. (a cura di), 1944 L’anno della storia, Ed. Darsena, Savona 2019. Calvino I., I sentieri dei nidi di ragno, Einaudi, Torino, 1947. Capogreco C. S., I campi del duce. L’internamento civile nell’Italia fascista (1940-1943), Einaudi, Torino, 2004. CLN, Resistenza e ricostruzione in Liguria. Verbali del CLN liguria 1044-1946, Feltrinelli, Milano 1981. Consiglio di Amministrazione S.C., Il Pio Istituto Santa Corona, Pietra Ligure 1965. De Marco N. – Ferro G., 1943-1945 La grande storia della Resistenza savonese, ANPI. Savona 2005. De Marco N., La guerra dei savonesi, ANPI, Savona 2002. Favretto S., Con la Resistenza. Intelligence e missioni alleate sulla costa ligure, Ed. Seb27, Torino, 2019. Folco U. (a cura di e del Comitato di Redazione), Storia del Santa Corona a Pietra Ligure. Microstoria della città di Santa Corona nel paese di Pietra Ligure, Azienda Litografica Genovese, Genova 2000. Gibelli A. (a cura di), La Resistenza in Liguria. Profilo e guida bibliografica, Amm.ne Prov.le Firenze, 2005. Gimelli F. – Battiflora P., Dizionario della Resistenza in Liguria, De Ferrari, Genova 2008. Gimelli F., Cronache militari della Resistenza in Liguria, 3 voll., La Stampa, Torino 1969. Gimelli G. (a cura di Gimelli F.), La resistenza in Liguria, 2 voll., Carocci, Roma 2005. [112] 26. 27. 28. 29. 30. 31. 32. 33. 34. 35. 36. 37. 38. 39. 40. 41. 42. ISREC (a cura di), Storia e memoria. Annali dell’Istituto Storico della Resistenza in Liguria, Franco Angeli, Milano, 1990. Jacobson L. (lettere di), Dal liceo ad Auschwitz, L’Arca, s.e. per l’Unità, Roma 1996, 1a CDDEJ, Lyon 1992. Malandra G., I volontari della libertà della II zona partigiana ligure (Savona), ANPI, Savona, 2005. Malandra G., Il distaccamento partigiano Stella rossa a Santa Giulia e Grottasecca, ANPI, Savona 2006. Malandra G., Le squadre di Azione Patriottica a Savona, ANPI, Savona 2003. Meinold G. – Scappini R., Il generale e l’operaio. La liberazione di Genova nei memoriali dei protagonisti, Deaprinting, Novara 2009. Millu L., Il fumo di Birchenau, La prora, Milano, 1947. Millu L., Dalla Liguria ai campi di sterminio, ANED,Genova, n.d. Moduli E, (a cura di), 1944 L’anno della svolta. Lavoro e Resistenza: gli scioperi del marzo, la deportazione operaia e il Patto di Roma, Ediesse, Roma 2015. Pellero F., Documenti della Resistenza armata savonese, Sabatelli, Savona 1978. Picciotto L., Il libro della memoria degli ebrei deportati dall’Italia, 1943-1945, Mursia, Milano 2002. Pisanty V., I guardiani della memoria e il ritorno della destra xenofoba, Giunti Editrice/Bompiani, Firenze-Milano 2019. Rebagliati F., Treni e partigiani del ponente ligure, Alzani ed., 2006. Salvaterra A., Un Ospedale nella resistenza, ANPI, Savona 1946. Taviani P. E., Breve storia dell’insurrezione di Genova, Le Monnier, Firenze 1982. Toscani G. (a cura di), Partigiani martiri della Resistenza, L.Editrice, Cairo Montenotte 2012. Wygoda H., All’ombra della svastica, ISREC Savona, 2006. [113] Nurses and Nursing in the XIXth Century in Cadiz (Spain) José María Montero, Juan Manuel García-Cubillana, Francisco Glicerio Conde University of Cádiz, Spain In this article we analyze the work of nurses at the Royal Hospital of Cádiz (founded in 1667) during the XIXth century, we study the evolution of the military nursing, its techniques, and its symbiosis with the Civil Health in the Bay of Cádiz. Almost we show the evolution of the Barber to the “Practicante”. Since 1791 the Royal College of Surgery of the Navy in Cádiz (founded in 1748) join medical and surgical treatments. The realization and methodology of this work was posible by the study of Primary sources include historical and legal documents in Archives, Secondary sources list, summarize, compare, and evaluate primary information and studies so as to draw conclusions on or present current state of knowledge in a discipline or subject. Almost the sources may include a bibliography which may direct you back to the primary research reported. In addition of this, we also analyze documents in Spanish Archives about Army and Health. The results are the evolution for better care explain in the next list: November of 1834 a resolution is established in which it is implanted that in the Navy they will serve practitioners instead of bleeding. In 1855 its optional scale was organized, integrating these practitioners. It was in the year 1857, 23 years later, when the figure of practitioners was created, in the civilian environment, and three years later, barbers and those who did not possess the title of practitioner were allowed to practice. The army medical branch was highly respected, and its Practitioners gained valuable experience in the war of Africa. Important work of Daughters of Charity of Saint Vincent de Paul in Nursing in Military Hospital of San Carlos in San Fernando (Cádiz) since 1870. We can conclude that in this century the functions and obligations of active military nurses are to: Treat wounded soldiers and other military personnel. The integration of practitioners, was very important to Spanish military health system, was very important for the Army. Quality and qualification of Spanish Military Nursing in XIXth Century. Bibliography 1. 2. Martínez Antonio, Francisco Javier, Salud pública e Imperio en la España Isabelina (1833-1868): el caso de la sanidad militar. História, Ciências, Saúde - Manguinhos [en linea] 2006, 13 (Abril-Junio). Orozco Acuaviva, A. (1976). Pedro Virgili y el Hospital de Cádiz: en el bicentenario de la muerte del fundador del Real Colegio de Cirugía de Cádiz. Medicina & historia: Revista de estudios históricos de las ciencias médicas, (63), 7-26. [114] La storia sanitaria dell’Ospedale Umberto I di Frosinone dal 1887 al 1946 Gerardo Di Giammarino Azienda Sanitaria Locale, Italy La storia dell’ospedale Umberto I tra il 1887 - 1945. Una storia che è stata raccontata da Gerardo Di Giammarino, il quale ha pubblicato, in questi anni, con il contributo della Banca Popolare del Frusinate e dell’Ordine dei Medici, due splendidi volumi sulla storia sanitaria frusinate e di conseguenza dell’ospedale Umberto I di Frosinone. I due tomi descrivono le vicende susseguitesi dal 1887, con la nascita del primo ospedale, per proseguire fino al 1944 quando avvenne il bombardamento della città e dell’Ospedale. In questi due volumi, è raccolta, attraverso documenti tratti dagli archivi, sia la storia infermieristica sia quella medica. Importante lo spaccato offerto sull’ assistenza sanitaria fino al riconoscimento delle arti salutari nel ventennio fascista. Importanti, anche, i passaggi sulle strutture sanitarie come il dispensario antitubercolare con le rispettive colonie per bambini, che restano la testimonianza di come la tubercolosi si propagò nella nostra provincia. In ultimo il bombardamento della città del 1943, protrattosi fino al maggio del 1944, segnano un momento difficile per la città, ma, al tempo stesso, la riapertura dell’ospedale nella città ospedaliera di Fiuggi dopo l ’ armistizio del 1943, segna una pagina di storia mai raccontata fino ad ora. Infine la liberazione del 1945 che segnò la ricostruzione della città e la ripresa dell’attività assistenziale a Frosinone. Frosinone è una delle cinque province del Lazio. Città volsca fin dalle sue origini seppe opporsi al dominio di Roma. Fino al 1871 fece parte dello stato pontificio e fu designata a Delegazione Apostolica di Campagna. La storia sanitaria della città di Frosinone affonda le sue radici intorno al 1682 quando il vescovo Asteo in visita alla città, visitò il piccolo ospedale S. Croce , situato all’interno del borgo cittadino come rilevato nella mappa del catasto Gregoriano. Nel 1834 l’osservatorio romano (Diario di Roma n 21 del marzo 1834) pubblicò un avviso per sopperire alla copertura della condotta medica per l’Ospedale resasi vacante . Nel 1852, la Delegazione Apostolica chiese al gonfaloniere della città di Frosinone se esisteva in loco uno Spedale , come fosse la sua gestione e il personale che vi lavorava. Nella risposta si specificò la presenza dell’Ospedale , gestito dalla Congregazione della Buona Morte e con un sussidio di 200 scudi da parte del Comune e venne elencato il personale che vi prestava la propria opera, medici , chirurghi, il chirurgo avventuriere, il flebotomo, le mammane, lo speziale ecc. Fino ai primi del 900 non si può parlare di sanità pubblica ma bensì di assistenza ai mendicanti, pellegrini o bisognosi da parte della Congregazione della Buona Morte e poi della Congregazione di Carità. Una forma assistenziale che si autofinanziava dai lasciti o dai canoni. E’ solo nel 1887 ,esattamente il 15 Agosto che venne inaugurato il primo Ospedale della città, realizzato grazie alla elargizione da parte dei cittadini frusinati di una cospicua somma pari alla metà del costo dell’opera e una parte con il finanziamento della Provincia di Roma .Frosinone non era ancora provincia , lo diventerà il 2 Gennaio1927con R.D.L. N 1. Il primo direttore sanitario dell’Ospedale fu il dottor Arnaldo Angelini, laureatosi a Bologna e nato a Perugia . Da subito dovette affrontare l’organizzazione dell’Ospedale, la formazione del personale di assistenza, e non ultimo l’arredamento con tutto il materiale per la sala operatoria .Per questo rinunciò a tre mesi di stipendio per raggiungere l’obiettivo. Grazie alla sua esperienza di chirurgo , l’Ospedale diventò un eccellenza per quel periodo tanto da portare ai congressi nazionali di chirurgia molti casi e monografie degli interventi eseguiti in loco. La relazione sull’Ospedale del 1895 da parte del Dottor Angelini , mise in evidenza le criticità della struttura tanto da porlo in contrasto con gli amministratori. La gestione ospedaliera da parte della Congregazione di Carità si scontrò con l’operato del Dottor Angelini fino al punto che nel 1897 fu costretto a rassegnare le dimissioni da direttore e primario chirurgo. La politica già in quel tempo determinava anche le scelte e le modalità dei ricoveri . Il dottor Angelini era ben stimato in città, apprezzato per il suo lavoro , e per questo nel 1901 fondò “ La casa della salute “ una struttura sanitaria con 12 posti letto, in via Garibaldi nel cuore della città dove mantenne saldi i suoi principi di assistenza sanitaria gratuita ai poveri. Al tempo stesso fondò un organizzazione sindacale dei medici condotti , relazionò con onorevoli eletti in parlamento per la difesa della figura del medico, organizzò congressi scientifici annuali della propria associazione. Grazie al suo temperamento votato alla solidarietà fondò in città la prima cooperativa per calmierare i prezzi “ La Concordia” e la nascita di un forno per la produzione del pane per tutti. Fu eletto membro del Consiglio dell’Ordine dei Medici della Provincia di Roma e il 13 gennaio del 1933 morì nella sua casa di via Garibaldi e si fece cremare ed oggi riposa nel cimitero del Verano (Roma). Dopo i primi del 900 la legislazione sanitaria in Italia cambiò , cercò in ogni modo di uniformare il paese dal punto di vista assistenziale. Il comune di Frosinone nel 1910 riscrisse il Regolamento organico e disciplinare del personale dipendente dalla Congregazione di Carità. Così pure durante il ventennio fascista vennero regolamentate le arti salutari, regolamentate le scuole convitto per infermiere ecc. Nel 1927 iniziò a dilagare in Italia la tubercolosi e Frosinone in quanto capoluogo di Provincia avviò le pratiche per la costruzione del dispensario antitubercolare. La stessa Provincia realizzò a Serapo(Gaeta) la colonia estiva per bambini. Nel 1933 l’Ospedale si dotò di un nuovo regolamento e naturalmente di natura restrittivo visto il periodo .Così pure gli stipendi , che nel 1934 portarono ad una indagine da parte del Ministero dell’Interno per i turni di dodici ore a fronte delle otto. Nel 1935 si costituì l’albo provinciale delle ostetriche e importante fu la figura di Sora Lucia , ostetrica. Una donna che laureatasi alla Mangiagalli di Milano per amore raggiunse la città di Frosinone dove da subito seppe farsi apprezzare ma al tempo stesso capì le condizioni economiche e sociali del territorio tanto da battezzare migliaia di bambini e nel periodo delle festività natalizie preparava doni alle partorienti da lei assistite e che vivevano in condizioni di indigenza. Nel 1942 l’Ospedale non rispondeva più alle esigenze del momento e pertanto si tentò con un progetto di ridare forma e nuovo aspetto ma ciò non fu possibile in quanto l’ente stesso non sarebbe stato in grado di sopperire ad un mutuo. [115] Dall’11 settembre del 1943, la città di Frosinone subì fino al maggio del 1944 cinquantasei bombardamenti .una città completamente distrutta , tra cui l’Ospedale civile .Grazie all’opera dei padri redentoristi , presenti durante tutto il periodo della guerra nella loro chiesa , riuscirono a salvare molto del materiale ospedaliero, letti, materassi, strumentazione della sala operatoria ecc, permettendo di far riaprire a Fiuggi diventata città ospedaliera, l’ospedale di Frosinone presso l’albergo Hotel Casa del Maestro con la divisione di Medicina, e la scuola elementare con la divisione di chirurgia. L’infermiera Margherita Malaguti Oggioni nel suo libro “Ricordi di un infermiera volontaria” edizione 1977 cosi scrisse: “Dopo l’armistizio dell’8 settembre, tutte le infermiere lasciarono gli ospedali che furono requisiti dai tedeschi. Questi avevano creato a Fiuggi una Città Ospedaliera sfruttando i molti alberghi della stazione termale. Un giorno si presentarono in ispettorato e si fecero dare l’elenco delle infermiere. Presero gli indirizzi e andarono nelle case a prelevarle per portarle a Fiuggi. Le infermiere portate a Fiuggi fecero il loro dovere curando e medicando ferite. Alla fine della guerra furono processate. Naturalmente a vuoto,” Per far comprendere quale fossero le condizioni sociali della provincia di Frosinone nel marzo del 1944 si riporta in breve la situazione degli ospedali Il Capo della Provincia di Frosinone, A. Rocchi, con lettera prot n 2110/ 47 bis, indirizzata al Ministero Agricoltura e Foreste, al Ministro degli Interni, al Partito Fascista Repubblicano Segreteria, rispondeva al dispaccio del 24 u.s., con oggetto “Situazione alimentare Riservata”, così scrisse: La Provincia dall’ottobre U.S. non riceve che in misura inadeguatissima generi alimentari; essi si compendiano esclusivamente in farina (in quantità notevolmente inferiore al fabbisogno) e in pasta (in misura ancora minore). Una provincia fra le più povere d’Italia, che da circa sette mesi non ha nulla e proprio nulla nei propri magazzini e che da qualche tempo ha la guerra nelle proprie terre. Non costituisce frase ne letteraria, ne impressionistica, dire che qui la fame e la miseria dilagano: i direttori di Ospedali, Prof. Moraldi Fiuggi, Prof. Zeri di Sora ecc, vengono a dirci che è vano curare clinicamente gli ammalati, quando non hanno loro gli alimenti da somministrare. Nel 1945 la città di Frosinone venne liberata dalle truppe canadesi . Il 20 giugno 1944 il comando alleato requisì un appartamento di 6 vani in Via Garibaldi 55 del Commendatore Pio Giansanti, che fu adibito a Pronto Soccorso per la popolazione civile. Gli alleati nel controllo dei fabbricati, rinvennero nella ex Casa di Salute del Dottor Arnaldo Angelini tutto lo strumentario chirurgico, la sala operatoria, in quanto non aveva subito danni dai bombardamenti. La stessa fu subito adibita a ospedale con primo soccorso alla popolazione.” Successivamente, constatato che il palazzo adibito a antitubercolare non aveva subito gravi danni, venne riattivato e fu così che ospitò l’Ospedale Civile con 60 posti letto. A questa riorganizzazione, fu importante l’opera del Dott. Ernesto Rea. L’Ospedale rimase in questa struttura fino al luglio del 1948. Bibliografia // [116] "L'Infermiere in Pratica": un manuale di Infermieristica del 1728 Claudia Polidori1, Antoinio Raschi2 1 Independent Scholar, Italy; 2CNR-IBE Introduzione Il manuale “L’infermiere in Pratica sopra la cura di tutti li morbi del corpo umano, ovvero compendio di arte medica” di Fra Mansueto di Brembilla Bergamasco, fu stampato in Venezia nell’anno 1728; insieme a “La Prattica dell’infermiero” di Fra Francesco Dal Bosco edito in Verona nell’anno 1664 sono i testi italiani più antichi, sino ad oggi noti, dedicati alla formazione infermieristica. Gli autori, entrambi religiosi, hanno svolto la loro opera nell’Italia settentrionale. Della vita di Fra Mansueto si sa poco, a parte l’aver ricoperto incarichi di responsabilità in Terra Santa per conto dell’Ordine dei Frati Minori. Ignota è anche la diffusione del suo trattato. Nella prefazione l’autore esplicita con chiarezza la sua intenzione: «.compongo questa mia operetta rivolta ai giovani principianti della professione medica, specialmente dei nostri infermieri, per agevolare l’apprendimento». «…Scrivo in forma di dialogo, rappresentando il discepolo che interroga il Maestro affinché dalle risposte del maestro il discepolo resti “appieno informato di quanto si ricerca alla cognizione di un buon infermiere». Struttura del testo Il testo è strutturato in cinque corposi capitoli: 1 Cura dei morbi capitali, 2 Cura dei morbi del torace, 3 Cura dei morbi dell’infimo ventre, 4 Cura dei morbi articolari, cutanei, delle estremità, della febbre in genere, della peste contagiosa, dei dolori in genere e del reumatismo, 5 Medicina in genere. Il percorso di apprendimento dei discepoli è diviso in quattro momenti: A Descrizione del morbo-malattia, B Cause interne o esterne che lo causano, C Segni/sintomi del morbo, D Uso del vitto e qualità dei rimedi per curare i morbi medesimi. Si ritiene opportuno presentare il colloquio di introduzione fra il discepolo e il maestro, che illustra le caratteristiche richieste a un buon infermiere. Domanda del Discepolo «La supplico d’insegnarmi per prima cosa, cosa si richiede per essere un buon Infermiere, per meglio adempiere alle sue incombenze, e la supplico di descrivermi il modo più proprio e più sicuro che io debba tenere nella cura di qualunque morbo,…. Ed anche di insegnarmi il buon uso dei Medicamenti le sue qualità, peso e misura e il modo di somministrarli ai poveri infermi con profitto dei medesimi». All’epoca la farmacopea si avvaleva degli effetti terapeutici delle piante officinali, spesso coltivate nell’orto dei conventi e “lavorate” nell’apposita spezieria dalla figura preposta, ovvero lo Speziale. Si risponde al primo quesito d’introduzione: si dimostra le qualità che deve avere un buon infermiere, e che cognizione deve avere per ben adempiere alla sua incombenza. “Per arrivare ad una perfetta cognizione di tal Arte si ricerca tutto l’uomo e tutta la vita dell’uomo, Ippocrate afferma nel primo dei suoi aforismi che “L’arte medica è ARS LONGA, VITA BREVIS, OCCASIO PERCEPS…” Che perciò si ricerca nel buon infermiere un intelletto perspicace, una ottima retentiva, una pronta volontà di affaticarsi, non solo nello studio della sua professione, ma nella pratica ancora. Gli si ricerca ancora un cuore tutto compassionevole per compatire le afflizioni dei poveri pazienti ed una carità ardente per soccorrerli in ogni sua indigenza. Inoltre è di necessità, che il buon infermiere sappia bene cosa sia l’arte medica, quali siano i suoi fondamenti, quali e quanti siano i suoi metodi, quale sia il fine e lo scopo di detta arte……Quando il buon Infermiere sarà arrivato ad una perfetta cognizione di tutte queste cose, potrà azzardarsi alla cura de’ mali particolari di tutte le parti del corpo, come degli universali….” il testo mutua il sapere infermieristico dal sapere medico. Peraltro, le caratteristiche che deve avere un buon infermiere non si discostano da quelle richieste oggi: intelligenza, desiderio di apprendere, buona memoria, non tirarsi indietro nelle situazioni faticose. E’ interessante notare come l’attività infermieristica venga già definita “professione”. Domanda del Discepolo “..la supplico di spiegarmi cosa sia la Medicina, quali siano i suoi fondamenti e quali siano i suoi metodi” Risposta del Maestro “la medicina figlio mio è un’Arte dell’uso, e dalla ragione costituita alla conservazione o restaurazione della sanità... la medicina è aggiunta e sottrazione, aggiunta a quello che manca, sottrazione di quello che sovrabbonda nei corpi umani» (Ippocrate)”. “…Galeno nel libro De Tuenda Sanitate assegna due differenze nell’officio di Medico, e divide la medicina in due gran parti, cioè una che difende la sanità difendendo i corpi dai malori, l’altra liberandoli dai medesimi nelle occorrenze”. ”osservabili agli infermieri studiosi….” “le cose naturali sono quelle delle quali la natura umana è composta...con il buon uso di quelle si conserva la sanità, con l’abuso di queste ne procede ogni sorta di malori ed in conseguenza la distruzione dell’umana natura le cose naturali sono sei: il mangiare e il bere, l’evacuare e ritenere, il sonno e le vigilie, l’aria e gli affetti dell’animo”. E ancora: «Il principio della natura umana sono gli elementi da i quali ne derivano i temperamenti ne provengono gli umori, dalle qualità degli umori si formano le parti, nelle parti del corpo si contengono gli spiriti risultano le potenze e le potenze eccitano le parti del corpo ad alcune azioni che si chiamano indizi di sanità». (Avicenna) [117] Il Maestro non si discosta dalla medicina classica. Preme tuttavia sottolineare come si distinguano la prevenzione e la cura. Inoltre i bisogni esplicitati sono assolutamente sovrapponibili ai bisogni successivamente descritti da Virginia Henderson (1955) nello specifico dell’assistenza infermieristica, derivati dalla piramide dei bisogni di Maslow (1954). Nei paragrafi seguenti sono riportati, in forma molto riassunta e schematicamente, parte degli argomenti trattati, estrapolati da una minima parte dei contenuti del testo. La struttura dell’uomo L’autore distingue le cose naturali, che costituiscono la natura umana (elementi, temperamenti, umori, parti del corpo, facoltà, azioni, spiriti) dalle cose non naturali, il cui buon uso conserva la sanità, mentre l’abuso causa “ogni sorta di malori” (mangiare e bere, evacuare e ritenere, sonno e vigilie, aria, affetti dell’animo) e infine dalle cose preternaturali (morbi, cause dei morbi, sintomi). Facendo riferimento alla medicina galenica, descrive gli elementi che compongono l’uomo, distinguendo i primi elementi: fuoco (calidità), aria (frigidità), acqua (umidità), terra (siccità) e li collega ai secondi elementi e ai terzi elementi (parti similari del corpo umano). Così, al fuoco corrisponde la bile flava (bile del fegato), e a questa, come terzi elementi, i nervi, i legamenti, i tendini; al fuoco corrisponde la bile atra (bile scura prodotta dalla milza), e a questa le vene e le arterie; all’acqua corrisponde la pituita (secrezione delle vie respiratorie e dell’esofago),e a questa le membrane e la cute; alla terra corrisponde il sangue, cui corrisponde il sangue stesso, come terzo elemento. I temperamenti dell’uomo L’autore correla i temperamenti umani con le aree di provenienza, affermando che nei Paesi temperati (Asia, Grecia, Italia) “I corpi umani sono più temperati, e, come attesta Ippocrate, ogni cosa nasce più grande, e più bella, gli uomini sono di costumi assai benigni, attivi, ingegnosi, ed inclini allo studio delle scienze”; nei Paesi freddi (Francia, Germania, luoghi settentrionali) “Gli uomini sono di temperamento molli, e frigidi, bianchi, e di costituzione grassi, le parti esterne facilmente si reffrigerano, ed interiormente possiedono un eccessivo calore, gli uomini riescono feroci ed animosi”; infine nei Paesi caldi (Indie, Africa, Etiopia) “I corpi degli uomini sono secchissimi e abbruciati e spesso piccoli di statura, e magari con la cute ruvida, crespa e nerizia”. Anche la qualità dei sogni dei pazienti viene correlata all’umore prevalente. Classificazione dei morbi La classificazione si basa sulla tipologia e sulla durata: - Morbi semplici: son prodotti in una parte sola del corpo e da una causa - Morbi composti: son quelli che vanno accompagnati con altri morbi in un sol corpo - Morbi acuti: son quelli che terminano in quattordici giorni o con la salute del paziente o con la morte - Morbi peracuti: son quelli che non trapassano il quarto giorno - Morbi brevi: sono quelli che presto terminano (e tali sono li morbi acuti e peracuti) - Morbi lunghi e cronici: sono quelli che oltrepassano i giorni quarantacinque - Morbi comuni: son quelli che in un tempo ed in un loco accadono a molte persone - Morbi maligni: son quelli che inferiscono gravissimi sintomi e pericolosi e difficili da curarsi - Morbi letali: sono quelli che per il più ammazzano l’uomo e per il più sono morbi peracuti - Morbi veementi: son quelli che con veemenza distruggono le forze ed è morbo pericoloso - Morbi legittimi: sono quelli che sono prodotti da una sola qualità - Morbi spuri: son quelli che non da un sol umore ma da più umori misti vengono originati - Morbi erratici: son quelli che non osservano alcun ordine ma vengono in tempo inaspettato ed improvviso - Morbi recidivi: son quelli che si rimettono bensì ma poco dopo ritornano col metodo di prima - Morbi universali: son quelli che aggravano e offendono tutto il corpo - ECC. Molta attenzione è dedicata alle caratteristiche del polso e delle urine, per la cui classificazione si basa sui testi di Avicenna (980-1037) e Giovanni Attuario (1275-1328), mentre il testo non prende in considerazione nessuna patologia dell’apparato genitale femminile. Bibliografia 1. Dal Bosco, F. (1664) La Prattica dell’Infermiero. Giambattista Merlo, Verona. 2. Di Brembilla, M (1728) L’Infermiere in Pratica. Lovisa, Venezia. 3. Maslow, A (1954). Motivation and personality. Harper, New York 4. Henderson, V. (1955). The Principles and Practice of Nursing. McMillan, New York. [118] L'assistenza ai feriti della Battaglia di Solferino: analisi delle fonti mediche dell'epoca Chiara Benedetti Spedali Civili di Brescia, Italy Il 24 giugno del 1859 si combatté a Solferino (a S. Martino e a Madonna della Scoperta) la battaglia “più sanguinosa della storia dell’intera umanità”: si fronteggiarono tre eserciti (francese, piemontese, austriaco) tre sovrani (Napoleone III, Vittorio Emanuele II, Francesco Giuseppe d’Austria), circa 250.000 soldati, 11.000 morirono e circa 45.000 uomini sarebbero stati feriti gravemente o dispersi. Dopo un feroce combattimento durato dal mattino alla sera le truppe franco-piemontesi sconfissero quelle austriache. Lo scontro lasciò un triste seguito di morti e feriti in un numero così alto da mettere in difficoltà qualsiasi organizzazione sanitaria. È notissima l’opera «Un Souvenir de Solférino» pubblicata nel 1862 da Henry Dunant che sensibilizzò gli animi e le coscienze, portando alla nascita della Croce Rossa Internazionale. In questa ricerca è riportata la testimonianza dal campo di battaglia di Solferino di due giornalisti americani del «New York Times»: uno di essi, un medico, scrisse reportage che verranno ripresi dalle riviste mediche coeve. Inoltre sono state esaminate riviste mediche italiane per analizzare come vennero descritte l’assistenza e le cure ai feriti. Le testate prese in considerazione (annate 1859-1862) erano le più importanti dell’epoca e riguardavano (anche geograficamente) la casistica clinica oggetto d’esame. Esse furono: «Gazzetta Medica Italiana. Lombardia»; «Gazzetta Medica Italiana. Stati Sardi»; «Gazzetta Medica Italiana. Provincie Venete»; «Annali Universali di Medicina»; «Liguria Medica» e il «Giornale di Medicina Militare del Corpo Sanitario dell’Armata Sarda». Le riviste sono state consultate presso la Biblioteca Medica degli Spedali Civili di Brescia, la Biblioteca “Vincenzo Pinali” antica di Padova, la Biblioteca dell’Ospedale S. Martino di Genova e presso l’archivio del “Giornale di Medicina Militare” al Policlinico militare del Celio a Roma. Il giornalismo di guerra indipendente, diffuso all’interno di redazioni e non propaganda di una Nazione o di un esercito, era nato durante la guerra di Crimea con i dispacci di due giornalisti che scrivevano per il «Times» di Londra: Thomas Chenery e William Russell. Le loro fedeli cronache fecero conoscere a Florence Nightingale e all’opinione pubblica mondiale l’orrore della guerra. Nel 1859, al di là dell’Atlantico, Henry Jarvis Raymond, direttore del «New York Times», simpatizzava per la causa patriottica italiana e chiese al suo corrispondente da Parigi, il medico newyorchese William Edward Johnston, di accompagnarlo nel nord Italia. Proprio la mattina del 24 giugno arrivarono al quartiere generale francese dove vennero avvisati che si stava combattendo una grande battaglia non molto lontano; essi ebbero modo di vedere il combattimento e soprattutto il grande numero dei feriti che in processioni interminabili, per tutta la giornata, a piedi o su carri trainati da buoi, si recavano verso Brescia per le cure sanitarie. I soldati più gravi erano lasciati a morire sul campo; i feriti curabili vennero raccolti a Castiglione delle Stiviere e da lì trasferiti negli ospedali della Lombardia orientale e del Veneto. Soprattutto a Brescia, città più vicina al campo di battaglia, che divenne il quartier generale dei soccorsi ai feriti. Qui, già alcuni giorni prima dello scontro, con la mobilitazione generale delle autorità politiche, religiose, civili, dei sanitari e di tutta la popolazione, erano disponibili tremila posti letto. Con lo scoppio della battaglia si allestirono nuovi nosocomi arrivando ad un totale di trentasette ospedali diretti dal medico bresciano Bartolomeo Gualla. Brescia, con una popolazione di 30.000 anime, ricevette pazienti (di tutte le nazionalità: alleati e nemici) in numero uguale ai suoi abitanti. Gli Americani scrissero lunghi resoconti già la notte del 24 giugno: infatti speravano che gli articoli potessero raggiungere Liverpool in tempo per la nave del 2 luglio. Così fu e le loro corrispondenze vennero pubblicate il 12 luglio, prima di quelle di tutti gli altri. Questo scoop del «New York Times» rimarrà una pietra miliare nella storia del giornalismo mondiale e Raymond venne celebrato come il «Russell americano in Lombardia». Johnston visitò gli ospedali di Brescia, parlò con centinaia di feriti, chiedendo la natura delle loro ferite e il modo in cui erano state curate e scambiando esperienze con i medici. Egli ci lascia dei resoconti molto precisi ed arricchiti dal suo “essere medico”; le sue cronache evidenziano la follia e l’orrore della guerra. Nell’articolo Interesting Details of the Results of Battle. Visit to the Hospitals at Brescia. Condition of the French Wounded and the Austrian Prisoners («New York Times», 16 agosto 1859) egli scriveva che in ogni ospedale vide da uno a cinque infermieri, un farmacista e un gruppo di signore in abiti di seta e crinoline che prestavano la maggior parte delle cure. Questi reportage, oltre che dal quotidiano inglese «Times» (Military hospitals in Italy,7 settembre), verranno ripresi dalla stampa medica: il settimanale organo della British Medical Association, il «British Medical Journal», il 10 settembre 1859 richiamava la corrispondenza di Johnston e sottolineava la grande carenza di personale medico adeguato. Riportava la difficoltà linguistica e l’incomunicabilità tra il personale sanitario e i ricoverati stranieri e le grandi mancanze riscontrate nel trasporto, nel trattamento chirurgico e nell’assistenza infermieristica. Molto probabilmente per via dell’elevato e non previsto numero di feriti ai quali provvedere. Il direttore dei trentasette ospedali allestiti in seguito alla Battaglia di Solferino, Bartolomeo Gualla, scrisse la relazione Breve cenno sugli ospitali militari provvisori di Brescia... (Brescia, Tip. Ist. S. Barnaba, 1859) dove descriveva minuziosamente gli ospedali, riportando per ognuno il personale medico incaricato, il numero dei feriti, la loro provenienza (se sardi, francesi, austriaci), i tipi di interventi chirurgici eseguiti e le malattie dei ricoverati. Questa relazione, oltre ad essere citata da Henry Dunant, venne recensita su una delle più importanti riviste mediche italiane dell’Ottocento (Breve cenno sugli ospedali militari provvisorii di Brescia..., «Annali Universali di Medicina», CLXIX, 1859, pp. 612-628). [119] Johnston, il medico giornalista, il 27 ottobre 1859 pubblica sul New York Times un articolo intitolato The losses at Solferino in cui si lamenta del fatto che il governo francese non aveva ancora comunicato il numero delle perdite. Egli legge la relazione del Gualla e riporta i dati statistici del medico bresciano che considera realistici e che gli fan scrivere: “Il totale complessivo delle perdite fra morti e feriti per l’esercito alleato fu di circa 45.000”. Questo articolo sul New York Times fece si’ che i dati di Bartolomeo Gualla venissero conosciuti e diffusi sulla stampa medica: inglese («Lancet», «Medical Times and Gazette») ed americana («Boston Medical and Surgical Journal» che diverrà, nel 1928, «The New England Journal of Medicine»). Anche sulle riviste mediche italiane apparvero articoli sull’assistenza, sulla terapeutica e sulla casistica di alcuni ospedali. Le conoscenze mediche dell’epoca erano ancora limitate: il materiale di pronto soccorso, lo strumentario e i medicamenti erano scarsi e inefficaci (Si ricorreva alle mignatte, ai purganti, emulsioni oleose, bevande refrigeranti subacide, solfato di chinina o decotto di china per le febbri, ad astringenti per la dissenteria ecc). Non si conoscevano i mezzi di sepsi/antisepsi (né le cause delle infezioni). Non esistevano metodi efficaci di anestesia né anestetici. A seguito delle operazioni potevano svilupparsi febbri di suppurazione, emorragie, tetano che mietevano numerose vittime anche a distanza di giorni, quando sembrava vicina la guarigione. Molto diffusi erano i disturbi dell’apparato digerente, le malattie gastroenteriche, dissenteria, le febbri reumatiche, bronchiti, polmoniti, tifo, vaiuolo, tetano. Pericolosa e temuta era la gangrena nosocomiale. Si ricorreva al salasso che portava l’ammalato ad una debolezza estrema. Particolare attenzione era dedicata alla dieta: in Italia si tendeva a nutrire i pazienti secondo un regime rigoroso che non era però seguito dai soldati Francesi. Su tutte le riviste è riportato il trattamento delle numerose fratture (causate dalle armi da fuoco) tramite l’immobilizzazione degli arti compromessi e l’utilizzo di bagni locali ghiacciati o impacchi con ghiaccio, mantenuto per ore sulle ferite. L’uso del freddo era uno dei mezzi più utilizzati nella cura di queste lesioni. Il numero altissimo di tali ferite era dovuto all’introduzione nei fucili di pallottole cilindro-coniche con le quali si otteneva una capacità lesiva e di penetrazione assai superiore a quella dei vecchi proiettili sferici (Dunant scrisse che questi nuovi proiettili «facevano scoppiare le ossa»). Francesco Cortese, medico divisionale di I classe e Vice Capo dell’Armata Italiana, scrisse (dal 17 ottobre al 26 dicembre 1859) un articolo che ebbe un grande successo editoriale e venne riportato sulle altre riviste (Considerazioni pratiche sulle ferite d’arma da fuoco osservate nell’ultima guerra, «Giornale di Medicina Militare del Corpo Sanitario dell’Armata Sarda», VII, 1859). Una delle più grandi questioni chirurgiche era quella tra indirizzo demolitore o conservativo relativamente all’amputazione degli arti. Sono da segnalare gli articoli che, dal 14 aprile al 16 giugno 1862, il giovane medico di battaglione Cesare Lombroso pubblicò sulle amputazioni, le disarticolazioni e le resezioni osservate fino al 1860 (Memoria sulle amputazioni…,«Giornale di medicina militare del Corpo Sanitario dell’Armata Italiana», X, 1862). Grazie ai resoconti dei giornalisti Raymond e Johnston, testimoni diretti della battaglia di Solferino, ai dati di Bartolomeo Gualla e agli articoli apparsi sulle riviste mediche dell’epoca si può avere una precisa panoramica della situazione sanitaria della «great battle and victory which will make the 24th of June a day long to be remembered in the history of the world» («New York Times», 12 luglio 1859). Bibliografia 1. 2. 3. Benedetti C. La formazione universitaria, le relazioni all'Ateneo e i libri del medico patriota Bartolomeo Gualla, in corso di pubblicazione. Benedetti C. “Le cronache dell’assistenza sanitaria sui periodici dell’epoca (New York, Nashville, Boston, Londra e realtà italiane)”. In: Cipolla C, Corsini P (a cura di). La genesi della Croce Rossa sul modello del cattolicesimo sociale bresciano. Milano, Franco Angeli, 2017, pp. 422-464. Benedetti C. “1848-1866. Verso l’Unità d’Italia: storie di cittadini, di guerre e di ospedali”. In: Brumana A, Ferraglio E, Giunta F (a cura di). Brescia contesa. La storia della città e del territorio attraverso secoli di dominazioni, assedi, battaglie e lotte fratricide. Brescia, Edizioni Misinta, 2013, pp. 411-419. [120] Issues of sustainability, recruitment and retention of a specialist nursing workforce: Over view of an Oral History project of Intellectual Disability Nurses from the Republic of Ireland and England, United Kingdom. Bob Gates, Colin Griffiths, Helen Atherton, Paul Suttton, Su McAnelly, Michelle Cleary, Carmel Doyle, Paul Keenan, Sandra Fleming The University of West London, United Kingdom This presentation was based on original research using the oral history approach to explore the careers of 31 intellectual disability nurses from England, UK and the Republic of Ireland. Understanding what drove them to work in this field of nursing practice, and learning lessons that might resonate with the current nursing workforce crisis underline the research undertaken. Data were gathered using semi structured interviews, and digitally recorded. These recordings now form a unique collection in the Royal College of Nursing’s, UK nursing history archives. With the now almost complete closure of intellectual disability hospitals in both jurisdictions, and the associated move from congregated to smaller living configurations, few practising intellectual disability nurses have experience, or knowledge, of the old ‘long stay’ institutions. Their stories, amongst other things, express a strong ‘sense of justice… doing the right thing and making a difference’. Some reported a ‘very early interest in working with people with intellectual disabilities’. And at ‘Journeys end’ sadly, almost universally, they reported a sense of being ‘undervalued’. Their narratives articulate the enormous health and social care changes they have witnessed over three decades or more. But above all else they give voice to their commitment, dedication, and kindness to a vulnerable, and often marginalised people, those with intellectual disabilities, and as such it gives voice to these otherwise ‘Untold Stories’. The project is cuurently being written up as a research monograph to be publsihed later this year. Bibliography 1. 2. 3. 4. 5. 6. 7. 8. McAnelly., S; Griffiths., C; Keenan., P; Flemming., S; Doyle., C; Cleary., M; Atherton., H; Gates., B and Sutton., P (2019) Untold stories: learning disability nurses. Nursing History Now. Autumn/Winter. pp. 6-7. Gates., B. (2018) Learning Disability Nursing could do so much more. Learning Disability Practice. 21. (1). 16. Mafuba., K; Gates, B. and Sivasubramanian., M. (2016) Achieving ‘sustainable safe staffing’ in learning disability services: is there any evidence? Health Work Evidence Briefs. London. University of West London. Gates., B; Mafuba., K. and Shanley., O. (2014) Final report of a systematic review of literature in the public domain on learning disability nursing staffing levels, and its relation to the safety, quality and the delivery of compassionate nursing care. London. Institute for Practice, Interdisciplinary Research and Enterprise, University of West London. Gates., B. (2011) Learning Disability Nursing: Task and finish Group: Report for the Professional and Advisory Board for Nursing and Midwifery - Department of Health, England. Hertfordshire University. Hatfield, Hertfordshire. Gates., B. (2011) Envisioning a workforce for the 21st Century. Learning Disability Practice. 14. (1). 12 - 18. Gates., B. (2011) The Valued People Project: user views of learning disability nursing. British Journal of Nursing. 19(22). 1396 - 1403 Gates., B. (2010) When a workforce strategy won’t work: Critque on current policy direction in England, UK. Journal of learning Disabilities. 14. (4). 2511- 258. [122] Collaborating with Collections – Nursing History for the Future Teresa Doherty Royal College of Nursing, United Kingdom The Royal College of Nursing (RCN) holds one of the most significant nursing history collections in the world. In collaboration with the RCN History of Nursing Society (HoNS) the collections continue to develop, not simply in size but in a complexity and depth that reflects the diversity of nursing practice. This paper will examine the different approaches used by the RCN Library and Archive Service (LAS) and HoNS to meet different needs. It will explore the audiences being developed, our relationships with wider nursing historians, and the internal and external importance of nursing history. It will investigate these by focusing on prominent collaborative projects such as the RCN Oral History Collection and the Dictionary of National Biography project. The paper will share successful collaborations between nursing historians and collection professionals; the importance of community history in a membership organisation; the continued need for academic nursing historians; the opportunities for international collaboration through digital platforms, and the importance of evidence for nursing practice. It will touch on challenges librarians and archivists face when building nursing history resources fit for the 22nd Century. The paper aims to inform nursing historians on how collections develop and how they might help build collections. It will raise awareness of new collections they can use and invite nursing historians to consider the new audiences they might reach through collaboration with heritage collections. Bibliography // [123] Retired and still Nurse - stories from retired nurses Ingrid B. Immonen UiT, The Arctic University of Norway, Norway Retired and still Nurse - stories from retired nurses Ingrid Immonen Associate professor, UiT The Arctic University of Norway, Campus Hammerfest, Norway Background for the project “Stories from retired nurses” The changes in society during the last 70 years are enormous, in knowledge, technology and social values. In health care this is reflected in diagnosing diseases, development of medicines, possibilities to cure, disposable equipment. Changes in society reflects in inner life in hospitals, community health care and education. It is easier to find data about changes in organization and new specialities than to find data on changes in inner life. The aim of the project, “Stories from retired nurses”, was to save nurses’ own stories, their experiences and memories, as well as their reflections on ongoing changes. Lately a lot of attention is given in Norway to the fact that a large number of nurses are quitting and changing to other professions. They are usually asked why they did quit. This led me to look into the interview material to see if I could find any keys that are important for remaining proud of your profession and identifying yourself as nurse still in your old age? Methods The first challenge for the project was to find interviewees. Living in Northern Norway means long and expensive travels. To minimize time and expenses focus on retired nurses in Finnmark County was chosen. To find interviewees Norwegian Nurses Organisation, branch Finnmark, sent an invitation to their registered senior members in Finnmark, in all 72. Also snowballing was used to find nurses that were not registered with Norwegian Nurses Organisation. In all 19 nurses participated in interviews, their age ranging from 70-85 when they were interviewed. Participants had their nursing training from various places in Norway and had passed their exams as Registered Nurses during the period 1953-1976. Interviewees are of both sexes, they have worked in hospitals, community health, and psychiatric health care. They have worked as ordinary nurses, as leaders and as teachers in nursing. As interview method focus group was chosen, but also some individual interviews were made where this was most practical. An interview guide and pictures were used as support. Focus group interviews differ from ordinary group interview in the way they are moderated. In focus groups participants are initial to which issues are discussed in detail and which are just passed by. Interviewer has the role of keeping the group on topic and helping on when there is a standstill. Groups met 2-4 times in sessions of 1,5-3 hours. Nurse education in Norway was regulated by law in 1948 and very detailed programs were made for schools that led to becoming a Registered Nurse. The programme regulated exact amounts of hours for each topic and who should teach (Nurses, doctors, clergy etc). Education was organized within the national Ministry of Social Affairs. During 1970s changes were demanded, and there was a process for nurse education to adjust to higher education. In 1981 nurse education was finally transferred to the Norwegian Ministry of Church and Education - Cultural Affairs. Thus all my informants had their exams from the first period. Findings Quite a number of thematic issues sprang from the interviews, i.e. about nurse education, nursing psychiatric and dying patients, leadership, further education, nursing skills, logistics of private lives. In this paper I discuss what makes these retired nurses identify themselves as nurses, still at an age of 70 to 90. They are active in participating in senior clubs, some are visiting senior homes with specially trained dogs, the younger ones still take on extra shifts as nurses. In early ‘50s and ‘60s the choices of further education were limited for girls. Nursing was one of few educations offered for them. As incentives to choose nursing, interviewees mention interest in helping people, having role models they looked to, and nursing being an education they could afford. The nurses reflect on changes since their time as students, especially in amount of responsibility they had, working hours, and living quarters (they had to live in at school). They also reflect on disposable equipment, new medicines, hygienic issues and new treatment. To be met as an individual person has been important both during education and during working years. Interviewees emphasise the fact that both teachers and nurses in the wards had time to meet them as students and discuss and debrief difficult situations. Of course they had different experiences in different wards. (Which actually in some cases determined their choice of specialization later on.) They also talk about the importance of balancing responsibility: “as students we had to do 14 nights alone with responsibility for the whole ward. Of course we learnt a lot, but it was not always in accordance to our competence”. And, last but not least, they talk about [124] feeling part of the ward or unit. “And when we were asked to do an extra shift, of course we needed the money, but it was also a proof of our nursing skills”. Interviewees reflect on working conditions as Registered Nurses, and changes for the better or worse: changes in hierarchy and openness in organisation, teamwork and lifelong learning. They also reflect on challenges in mentoring students in practical placement. In their opinion learning in practice will lay the foundation for how they regard their profession later. “And we are not able to follow up students properly these days”. There seems to be almost no time nowadays, they say, to repeat procedures until they are internal in students and til students have them in their fingertips, or to find enough time to instruct and give feedback. This, they say, is due to patients staying shorter time in hospitals, outsourcing of part of the work in the units (for instance meals), more students per nurse, splitting up of units in smaller teams – “my patient and your patient”. Family life is an extremely important issue when working in a profession where shift work is part of daily life. Most of the nurses had families and children, and everyday logistics were an extremely important issue. It is also important to have an opportunity to develop skills, either through internal courses or formal education. It is the leader’s responsibility, they underline, to confirm an open policy where all can feel equally important, doctors, nurses and other staff alike. It is important for individual development as well as for developing the ward. Dicussion “It is hard on feet and back, but I love the work.” “I would not change for a million.” So, what do nurses stress as important positive factors in their work? To be seen and heard: All interviewees stress the importance of being seen and heard. First as students, later as nurses and leaders. This they say was easier “in their time” as classes were smaller, they had longer periods in practical placements and students felt part of the ward. Today nurses feel that students are guests in the ward. Leadership in nursing units: “We”, not “we and they”. Wards and units have a tendency to split in smaller units or tasks these days. And so responsibility for patients becomes an individual, not a joint task. Interviewees also point out the importance of “short way” (literally, “open door policy”) to leaders, and thus having an opportunity to feel part in developing the ward. This is important both in discussing problems related to daily work and for proposing changes. “Nowadays I feel I am valued for what I cost my unit, not for my professional skills.” Development, personal as well as for the ward or unit. Courses and further education give work satisfaction. Cross professional meeting points are stressed, it gives satisfaction both in personal growth and in pride in one’s working place. Still, this demands stability over time in staff. Everyday logistics: logistics in private life can be difficult when working as a nurse, usually working shifts. One seemingly small, but extremely important factor is opening hours for kindergarten. Conclusion How can we use reflections and wisdom from retired nurses in order to help students stay proud of their chosen profession? This is important as there is prophesized a shortage in nurses in near future. Which is the wisdom from elderly nurses reflections? • • • Is it possible to have time and opportunity to see and hear students and colleagues? include all in a working team? How are we valued for our professional skills? Is it possible to manage every day logistics? • Is it possible to implement this in modern values, organization and leadership? Readings CIRN (Centre for Interdiciplinary Research on Narrative) http://stu-sites.ca/cirn/index.aspx Fause, Å. and Micaelsen, A. (2002): Et fag i kamp for livet. Sykepleiens historie i Norge. Fagbokforlaget, Bergen, Norway Lerdal, A., & Karlsson, B. (2008). Using focus group interviews. Bruk av fokusgruppeintervju, Sykepleien Forskning, 2008, Vol.3(3) Mathisen, J. (2006): Sykepleiehistorie. Ideer - mennesker - muligheter. Gyldendal Akademisk, Oslo de Medeiros, K (2016): Narrative Gerontology: Countering the Master Narratives of Aging. Narrative Works Volume 6, issue 1, p.63-81 https://journals.lib.unb.ca/index.php/NW/article/view/25446 Bibliography 1. 2. Immonen, Ingrid B., Litt om sykepleie på brakka og første tiden på det nye sykehuset.. Øyfolk. Årbok for lokjalhistorie og kultur i Hammerfest 2019;Volum 30. s. 171-175, UiT . Fra Hammerfest sykehus historie. Øyfolk. Årbok for lokjalhistorie og kultur i Hammerfest 2018 ;Volum 29. s. 86-100, UiT. Tanker om yrkesstolthet. Tidsskriftet sykepleien 2018, UiT. [125] The trail of an idea struggling for survival: Jean Mackie Establishes Canadian Nursing Education at Mount Royal College, 1965-68 Marg Olfert Mount Royal University, Canada In the mid twentieth century in Canada, looming nursing shortages dominated the agendas of provincial governments while nursing associations were engaged in the struggle for control of the evolving profession. For Mount Royal College, a religious based institution about to become public, the initiation of a two-year nursing education program was a means to establish its independence in education. Jean Mackie, a nurse educator who recognized limitations in hospital-controlled nursing education, was hired to lead the program. This paper is about a missing piece of history in most books that describe nursing education in Canada – the two-year programs in colleges or technical institutions that bridged the gaps between hospital-based programs and baccalaureate programs that are now offered by universities in Canada. These two-year programs in colleges were the first to be offered outside the control of hospitals, and made significant impacts on nursing education. The next step of baccalaureate as entry to practice, could not have happened without this step. In this historical analysis, primary sources include Mackie’s writings about her evolution of thinking about nursing education, and the first three years of her experiences in establishing a program unlike any seen in Canada. Letters written by Mackie, newspaper clippings, and oral histories from first graduates of the program were analysed. Secondary sources include historical accounts of the educational institution, and of nursing leaders in Alberta, Canada, and the United States. By 1927-8, it was generally agreed that the training of nurses in Canada was unsatisfactory. And that an investigation from coast to coast should be conducted, by a competent person experienced in the direction of such surveys, and belonging to neither of the professions. In 1929 the work began - Dr George M. Weir, a professor from the University of British Columbia (head of the department of education at UBC), was commissioned by the Canadian Medical Association and Canadian Nurses Association, to conduct the survey. Every province was visited; this was a strong indication of the importance of the work, as travel would not have been easy, using the steam train as the provinces were almost 4000 miles from coast to coast. Weir (1932) recommended against revamped medical lectures that were being used to educate nursing students, and advocated against overworking student nurses or making them primarily economic assets to the hospitals. Despite the recommendations, thirty years later, hospital-controlled education persisted – but was seen to have significant limitations; it was largely criticized by nursing leaders of the day. However, it was difficult to break the ‘evil spell’ – Russell (1958) saw that while the Canadian Nurses Association had grown in size and strength and had enabled Canadian nursing to expand its services, the evil spell persisted, which she described as the “saddling of hospitals with the total responsibility for nursing schools and the encumbering of our schools with responsibility for hospital service“ (p. 529). Dr Helen Mussallem served as the CNA's executive director from 1963 to 1981, and her survey about nursing education concurred with Weir that hospitals using students as workforce was a problem, hours on duty were too long, nursing classroom instruction was limited and insufficient, teachers were ill-prepared and too few in number (Ross-Kerr, p. 132; Mussallem, 1960, p. 82-85). She also recommended that professional nurses should be educated in universities and become baccalaureate prepared (p. 90). However, even if that were to occur, it was well known that universities could not take up the void to educate the numbers needed. An interim step would be needed. A nurse leader with experience in adventure would soon take up the challenge. In 1937, at the age of 21, Evelyn Jean Mackie participated in an effort to open a trail through mountainous terrain in northwestern Alberta, to enable goods to reach coastal markets. The efforts were led by Alex Monkman, a Metis man from Manitoba, as he and a group of dedicated and energetic people lobbied government unsuccessfully, to make a highway. Mackie had finished high school and was bored, and there were no finances to further her education. Even though her relatives were concerned about her going on this trek to open a trail to make way for highway to the west coast, her parents were assured it would be safe, and she went along as assistant cook. Her letters back to her mother indicated she enjoyed the responsibility and the work. Jean received her nursing education at a hospital-based program in Edmonton Alberta, Canada. Later as a nurse educator, she challenged the existing state of nursing education, forging her own distinct path. Mackie noted that Nightingale recognized that students were being “exploited for service” in hospital-based education. Mackie also believed that the length of a program could be shortened as Montag had: “less learning time is needed when the learning experiences are carefully selected.” Some key influences of Mackie were leaders that had an impact as disruptors of the times in two nations: Dr Mildred Montag was American, and Gertrude Hall was Canadian. Montag’s doctoral dissertation from Teachers College, explored the creation of technical training through associate degree programs, and had a sweeping effect on the way nurses are trained in America, and Canada. Mackie attended a conference on Nursing Curriculum in 1966 in Denver, Colorado, offered by Dr Mildred Montag. Mackie wrote that only two applicants from Canada were accepted, and that Dr Montag was very interested in what was being planned and expressed both encouragement and sympathy for the ‘struggle ahead’. To learn more, Mackie decided to teach at the associate degree program at Everett College, Washington state, and became convinced that “less learning time is needed when the learning experiences are carefully selected and organized and the teacher and student can concentrate on teaching and learning” – quoting Montag’s words at the workshop. During Mackie’s time teaching at the Calgary General Hospital School of Nursing, Gertrude Hall was also a key influence on Mackie’s approach. Hall had penned an article in the national journal, the Canadian Nurse in 1940, which expressed impatience with the current [126] system: “As long as we must continue to think in terms of nursing service to the hospital as of major importance, and the preparation of the nurse always as secondary, can we ever hope to build a sound educational program?” (Hall, 1940, p. 555) Mackie was hired by then Mount Royal College in 1965, to develop and lead the first two-year nursing program in an educational institution in Canada. Mackie believed that if education was student-focused and planned, two years would be adequate to educate a clinical nurse. The challenges that Mackie identified in hospital-based education programs included that they were too procedurecentred, with too much routinized patient care, and that they lacked the general education which would have promoted personal growth. Mackie had some misgivings as to her own readiness to cope with external barriers, such as the province was not convinced for the need for change in nursing education, and about the role of junior/community colleges, which was still being determined. However, Mackie attempted to modernize the educational program. She was committed to admitting all ages, genders, marred or single, and to promoting the liberal arts that would be possible at the junior college setting. Mackie turned out to be a skilled administrator, using her previously formed connections/relationships with hospital directors to form advisory committees, which was key in securing clinical placements, as this had not been done before. An example of Mackie’s articulate, respectful, excellence in communication was her response to a Catholic Hospital Association of Canada publication, in which the Mount Royal two-year program was questioned and suspect in producing nurses with the sacred ideals required. Mackie described the diversity the college program would bring as an asset – and that men and women, of all ages, and married or single would be welcome. She also quoted Montag in her reply, stating that curriculum would be supported by college faculty and nursing faculty, and that two years was adequate if planned and ffocused on principles of learning, more than sacred duties (Mackie, Letter to Editor, 1967). The contribution of Mackie and others of this evolution of nursing education has not been recognized for its significance. Mackie was a leader who has not been recognized, and her work was significant as the she was the first to achieve the goal of nursing education established in an educational institution. History should regard the move to educational institutions as an integral move forward, toward pedagogies that are education and learning-centred, toward liberal arts-based education, toward legitimacy as an autonomous profession, and ultimately toward opportunities to achieve baccalaureate as entry to practice in Canada. The development of two-year college nursing education programs has received little attention from Canadian historians, or is merely a footnote as baccalaureate education would became the minimal requirement for entry to practice. Given the institutional barriers and paternalistic forces at play, Mackie’s pragmatic and persistent leadership style are integral in securing a place in nursing education history. Bibliography 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. Alberta Government. (1975). Alberta Task Force on Nursing Education. Author. Baker, D.N. (20011). Catch the gleam: Mount Royal, from college to university, 1910-2009. University of Calgary Press. Boschma, G. (2005). Faculty of nursing on the move: Nursing at the University of Calgary, 1969-2004. University of Calgary Press. Brown, E. L. (1948). Nursing for the Future: A report prepared for the National Nursing Council. Russell Sage Foundation. Byers, E. K. (2009). Guardians of the Lamp: The Calgary General Hospital and its Nursing School Remembered. McAra Printing. Costello, C. G., & Castonguay, T. (1969). The evaluation of a two-year experimental nursing program. Regina Grey Nuns Hospital. Jacobs, L. A., DiMattio, M.K., Bishop, T.L., & Fields, S.D. (1998). The baccalaureate degree in nursing as an entry-level requirement for professional nursing practice. Journal of Professional Nursing. 14(4), 225-233. Lewenson, S.B, & McAllister, A. (2015). Learning the historical method: Step by step. In M. De Chesney, M (Ed.). Nursing research using historical methods: Qualitative design and methods on nursing (pp. 2-21). Springer. Lord, A. R. (1952). Report of the evaluation of the Metropolitan School of Nursing, Windsor, Ontario. Canadian Nurses Association. Mackie, E.J. (1981). A biographical history of the nursing program at Mount Royal College, Calgary: Part One – The first three years (1965-1968). Calgary, Canada. Mackie, E.J. (1981/1986). The first decade: Diploma nursing program, Mount Royal College, Calgary, 1963-1973. Calgary, Canada. Mansell, D. J. (2004). Forging the future: A history of nursing in Canada. Thomas Press Publication. Mussallem, H. K. (1960). Spotlight on nursing education: The report of the pilot project for the evaluation of schools of nursing in Canada. Canadian Nurses’ Association. Mussallem, H. K. (1964). A path to quality: A plan for the development of nursing education programs within the general education system of Canada. Canadian Nurses’ Association. Palmer, S. (2013). Windsor’s Metropolitan Demonstration School and the reform of nursing education in Canada, 1944-1970. In P. D’Antonio, Fairman, J. A., & Whelan, J. C. (Eds.). Routledge handbook on the global history of nursing. Routledge. Ross-Kerr, J. C. (1998). Prepared to care: Nurses and nursing in Alberta. The University of Alberta Press. Russell, E. K. (1958). Changes in the patterns of nursing. The Canadian Nurse, 54 (6), 529-532. Truax, M. F., & Sheehan, B. F. (1988). People of the pass: A human interest story of the Monkman Pass. Menzies Printers & Stationery. [127] 18. Weir, G.M. (1932). Survey of nursing education in Canada. The University of Toronto Press. Wesleyan University. (n.d.). Historical analysis: General information. Retrieved from http://govthesis.site.wesleyan.edu/research/methods-and-analysis/analyzing-qualitative-data/historical-analysis/ 19. Wood, V. (1984). Nursing education: The move from hospital schools of nursing – an historical perspective. International Journal of Nursing Studies, 21(3), 183-192. [128] Organization of education of nurses in Poland – genesis Małgorzata Barbara Marcysiak Department of Nursing and Postgraduate Education, Department Faculty of Health Sciences and Social Sciences, Ignacy Mosciski’s University of Applied Sciences in Ciechanów; Polish Nursing Association, The Commission of History at the Polish Nurses’ Association Main Board, Poland Introduction Nursing history is inseparable from the history of medicine. One of the first who has identified activities of nursing care was a Greek physician – Hippocrates. Although nursing was already known in antiquity, about nursing as a profession we could be talked since the 18th century with the appearance of the first lay nurses. However, it could be considered that the first forms of education (courses) for the staff who taking care for sick in Poland, began as early as the 17th century. In 1652, Jan Kazimierz brought the Congregation of St. Vincent de Paul. The company prepared Daughters of Charity, but also lay volunteers with a high moral standing to perform an auxiliary role in care for sick. Undoubtedly, Florence Nightingale was role model for the organization of the education, who opened the first school for nurses at St. Thomas' Hospital in London in 1860. She specified the requirements for candidates for this profession. However, before Poland regained independence already during the partitions attempts were organized to organize education. In 1895, a nursing school was established at the Universal Hospital in Lviv, in 1905 - School of Nursing of Doctor Alexander Fruchtman, next in 1906, education was organized in Łódź. In 1908 another form was created in Warsaw. In 1910 began a school of doctor Starzewski. In Krakow, in November 1911, the first, modern Vocational Nursing School of the Association of Ladies' Economics of St. Vincent de Paul. In view of the widespread social and infectious diseases and excessive mortality in Poland, after regaining independence, there was a need for professional training of nurses. They had to demonstrate a high independence, initiative, knowledge of the organization of health services, responsibility and professionalism. The high requirements posed by the nurses were reflected in the education curricula and teaching methods of schools of nursing. Objective The aim of the study was to learn the organizations and rules in force at the beginning of professional nurse education. Material and method The method of study of documents, including the analysis and criticism of literature. The subject of analysis was the Polish medical periodicals and society, archives, printed sources and studies. Results Professional preparation of nurses was the issue of discussed during international conferences and congresses, as large discrepancies in the preparation of personnel and level of education in different countries were noticed. The dominant role was played by the International Council of Nurses (ICN). Congresses of the organization were held in Copenhagen (1922), Helsinki (1925), Geneva (1927), Montreal (7-14 July 1929), Paris and Brussels (14-20 August 1933) and London (18-24 July 1937). The agreed program was to serve as guidelines, depending on the situation, needs and opportunities of each country. The most important part of the curriculum was considered: - to provide theoretical knowledge based on scientific principles; - he possibility of acquisition of practical skills for nursing concerning caring for patients with different problems in all periods of life, conducting medical treatments and hygiene procedures and health education; - developing the right attitude regarding professional ethics. In the interwar period in Poland were eight schools educating nurses: two in Poznan, three in Warsaw and one each Krakow, Katowice and Lviv. The initiators of the creation of schools were central and local government and social organisations. The financial support was primarily provided by the American Red Cross and the Rockefeller Foundation. The Warsaw School of Nursing was the first nursing school organized after Poland regained independence. It was founded in 1921. The first director was the American – Helen Bridge. She performed this function until 1928. From 1928, the Foundation Council appointed Zofia Szlenkier as the director, and then in 1936, Jadwiga Romanowska – a graduate of the first team of the Warsaw School of Nursing. The school was founded on the initiative of Ignacy and Helena Paderewski and Henryk Sienkiewicz. It was founded from private financial donations. Her sponsors were: Dorothea Hughes – American nurse of Polish origin, American Red Cross, Rockefeller Foundation, Polish Red Cross, Ministry of Health and the Faculty of Medicine of the University of Warsaw. Polish Red Cross Nursing School in Poznan was founded in 1921. The teaching and management staff to 1924 was formed by American instructors (Ita Rosa Mc Donell, Emilia Skorupa), and next Polish (Elżbieta Rabowska, Irena Radajewska, Anna Martinówna and Maria Jędrzejowska). The training program was based on patterns of American schools of nursing, but the content of teaching and practical training was adapted to the needs of Poland. School of Jewish Hospital in Warsaw was established in 1923. The first headteacher was American - Amelia Greenwald, and then Polish - Sabina Schindlerówna and Nina Lubowska. [129] University School of Nurses and Hygienists in Krakow was established in 1925. School was directed by a Polish nurse Maria Epsteinówna and then Anna Rydlówna. Polish Red Cross School of Nursing and Social Work in Katowice was created in 1927. Although it was really needed, in Silesia Region, but was functioned for only 2 years. The reason for its closure was too low census of candidates. It was associated with differences in education system in Silesia and the lack of program changes. Polish Red Cross School of Nursing in Warsaw was established in 1929. Director of school was responsible in front of the Main Board of the Polish Red Cross. The first headmaster was Polish - Helena Nagórska and then Małgorzata Żmudzka. Students signed an official commitment stating that after graduating from the school, they would join the Sisters of the Polish Red Cross Corps for at least 3 years. A School of Social Nurses of Social Union of Sickness Fund was created in 1932 in Poznan. The school operated for only two years, because the representatives of the Department of Social Security Office said that it is not financially efficient. Public School of Nursing at the General Hospital in Lviv started operating in 1937. School educated, next to nuns, secular women, too. The school of Lviv, in contrast to the other schools, had the following administration: hospital director in fields of administration and school director in field of science. The hospital's director was doctor Podhorecki, the school's headteacher was a nun Zofia Łuszczkiewicz. Schools were autonomous. Have their own budget, charter and management. Terms defined the duties of a schoolgirl, in particular: the principles of hygiene, punctuality and diligence in attending classes. Schools were closed institutions. Boarding school was compulsory. Accepted candidates have a certificate of completion of six classes of high school. The most important part of the curriculum was to provide theoretical knowledge, acquire practical skills and adherence to professional ethics. Education and staying in the hostel were paid. Most of the students benefited from discounts, and training costs charged to government subsidies. Charges were from 60 to 160 zł. In 1937 the structure of female students was mixed, although the candidates for the nursing profession originated mostly from the intelligentsia which accounted for 59%, from the families of miners, rail workers and policemen – 22%, from the smallholders – 15% and from the landowning – 4%. The duration of study was from 2 years to 2 years and 4 months in different schools. Theory included from 6 to 8 months (lectures), the practice from 14 to 19 months. Practice took plan in the clinics, social institutions, and schools. Curriculum concerned departments such as: nursing the sick, disease prevention and health promotion. The program implemented the "block" system (separation of the theoretical from the practical) or a system of "common" (creating the theory together with practical sessions). Learning was divided into three periods of theoretical classes, which were interspersed with practice. The first period included the natural sciences, biology, nursing principles, hygiene. The second and third – pathology, internal medicine, surgery, childhood diseases, obstetrics and gynecology, infectious diseases, mental, dermatology, and finally social nursing. Only after the third term, students' practice could take place in health facilities and clinics, preparing to work in a work environment. Nursing school required fulfillment of conditions. These included proper facilities: the classrooms - a lecture hall, demonstration hall, kitchen, dietary, laboratory, office, dining room, recreation room, bathrooms, and teaching aids, which were models and systems. The final exam consisted of: - a written report from the 8-hour on-call at the designated patient, - a practical test in the demonstration hall covering the principles of nursing, - an oral examination, which covered the range of curriculum. Conclusions 1. As a result of actions taken to rise qualified nurses. 2. Insufficiency observed in the preparation of professional nurses in public health, especially for work in the countryside. 3. It was necessary to increase the number of schools and modify the educational program. Key words: education, organization, nurses, Poland Bibliography 1. 2. Recent publications by the first author: Małgorzata Marcysiak, The development of social nursing as a department of social medicine on the example of the Lviv region in 1929-1939, Institute of the History of Science of the Polish Academy of Sciences, Warsaw 2018. Małgorzata Marcysiak, Nursing care in the realities of the Ciechanów Powiat in the interwar period, in: Bożena Urbanek (ed.) Medicine of the Polish Borderland of the Second Polish Republic of 1918-1939, Institute of the History of Science of the Polish Academy of Sciences, Warsaw 2018, pp. 229-261. Bibliography for the article (abstract) [130] 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. Archiwum Akt Nowych (AAN) - Archives of Modern Records (AMR), Ministerstwo Opieki Społecznej (MOS) - Ministry of Social Care (MSC), sygn. 574, k. 14. AAN (AMR), MOS (MSC), sygn. 574, k. 28, Regulamin egzaminu końcowego w Państwowej Szkole Pielęgniarstwa przy Szpitalu Powszechnym we Lwowie (Terms of the final exam at the National School of Nursing at the General Hospital in Lviv.). AAN (AMR), MOS (MSC), sygn. 574, k. 32-33, System nauczania (Teaching system). Babicka M., Przyczynek do historii pielęgniarstwa w Polsce (Contribution to the history of nursing in Poland), „Zdrowie” („Health”) 1927, rok XLII, nr 3. Badania psychotechniczne w Uniwersyteckiej Szkole Pielęgniarek i Higienistek w Krakowie (Psychotechnoical resarch in the University School of Nurses and Hygienists in Krakow), „Pielęgniarka Polska” („Polish Nurse”) 1936, rok VIII, nr 3. Bridge H.L., O kształceniu pielęgniarek (The education of nurses), „Pielęgniarka Polska” („Polish Nurse”) 1929, rok I, nr 1 Bujalski J., Z zagadnień pielęgniarstwa (With the issues of nursing), „Lekarz Polski” („Polish doctor”) 1937, rok XIII, nr 11. Dwadzieścia lat publicznej służby zdrowia w Polsce odrodzonej 1918-1938 (Twenty years of public health services in reborn Poland 1918-1938), MOS (Ministry of Social Care), Warszawa 1939. Fundacja Rockefellera w Polsce (The Rockefeller Foundation in Poland), „Pielęgniarka Polska” („Polish Nurse”) 1937, rok IX, nr 6. Gołębianka S., Dokształcanie absolwentek Szkół Pielęgniarstwa w zakresie Zdrowia Publicznego (School of Nursing graduates further training in Public Health), „Pielęgniarka Polska” („Polish Nurse”), 1929, rok I, nr 5-6. Jezierska M.B., Pochylone nad człowiekiem. Z dziejów Warszawskiej Szkoły Pielęgniarstwa (Bending over the Patient. One the History of the Warsaw School of Nursing), Stowarzyszenie Redaktorów, t. I., Warszawa 1994. Kacprzak M., O konieczności szkolenia pielęgniarek i higienistek (The need for training of nurses and hygienists), „Zdrowie” („Health”) 1930, rok XLV, nr 23. Kaniewska-Iżycka J., Rozwój pielęgniarstwa w Polsce do roku 1950 (The development of nursing in Poland until 1950), Centrum Metodyczne Doskonalenia Nauczycieli Średniego Szkolnictwa Medycznego, Warszawa, 1987, cz. I. Kongres Międzynarodowej Rady Pielęgniarek (Congress of the International Council of Nurses), „Pielęgniarka Polska” („Polish Nurse”) 1937, rok IX, nr 11. Kucharski T., W sprawie pielęgniarstwa (In the case of nursing), „Lekarz Polski” („Polish Doctor”) 1937, rok XIII, nr 11. Maksymowicz A., Zagadnienia zawodowe pielęgniarstwa na tle historycznym (Professional nursing issues in the historical background), PZWL, Warszawa, 1977. O pielęgniarstwie i pielęgniarkach (The nursing and nurses), „Pielęgniarka Polska” („Polish Nurse”) 1924, rok I, nr 1. Przywieczerski W., Pielęgniarstwo w Polsce (Nursing in Poland), „Polski Czerwony Krzyż” („Polish Red Cross”) 1933, rok XIII, nr 3. Rozporządzenie Ministra Opieki Społecznej z dnia 17 marca 1936 r. o pielęgniarstwie (Regulation of the Minister of Social Care, 18 march 1936), (Dz. U. 1936, nr 28, poz. 229). Sprawozdanie z Międzynarodowego Zjazdu Pielęgniarek w Kanadzie (Report of the International Congress of Nurses in Canada), „Pielęgniarka Polska” („Polish Nurse”) 1929, rok I, nr 5-6. Sprawozdanie z VII Walnego Zjazdu PSPZ (Report on the VII General Assembly PSPZ), „Pielęgniarka Polska” („Polish Nurse”) 1932, nr 8-9-10. Statut Państwowej Szkoły Pielęgniarstwa we Lwowie (Statutes of the State School of Nursing in Lviv), § § 3 i 5. AAN (AMR), MOS (MSC), sygn. 574, k. 14. Stypułkowski S., Walka z chorobami społecznymi (The fight against social diseases), „Opiekun Społeczny” („Caseworker”) 1938, rok III, nr12. Suffczyńska J., Kongres Międzynarodowej Rady Pielęgniarskiej (Congress of the International Council of Nurses), „Pielęgniarka Polska” („Polish Nurse”) 1937, rok IX, nr 11. Suffczyńska J., Międzynarodowe Stowarzyszenie Pielęgniarek (International Nurses Association), „Polski Czerwony Krzyż” („Polish Red Cross”) 1929, rok IX, nr 3. Suffczyńska J., Zasadnicze warunki zakładania i prowadzenia dobrych szkół pielęgniarstwa (The essential conditions for the establishment and pursuit of good schools of nursing), „Polski Czerwony Krzyż” („Polish Red Cross”) 1931, rok XI, nr,3. Szkoła Pielęgniarek Społecznych Związku Kas Chorych w Poznaniu (School of Social Nurses of Social Union of Sickness Fund), „Pielęgniarka Polska” („Polish Nurse”) 1933, rok V, nr 7-8-9. Urbanek B., Kształtowanie statusu zawodu pielęgniarskiego na ziemiach polskich w latach 1830-1938 (Forming the status of nursing profession in the Polish territories during 1830-1938), w: A. Żarnowska, A. Szwarc (red.), Kobieta i praca: wiek XIX i XX, zbiór studiów (Woman and work: the nineteenth and twentieth century, a collection of studies), DiG, Warszawa 2000. Ustawa o pielęgniarstwie z dn. 21 lutego 1935 (Act of nursing, 21 february 1935), (Dz. U. R. P. nr 27, poz. 1999). Wroczyński Cz., O zawodzie pielęgniarek (The nursing profession), „Polski Czerwony Krzyż” („Polish Red Cross”) 1928, rok VIII, nr 11. Wroczyński Cz., Szkolenie pielęgniarek (Training of nurses), „Zdrowie” („Health”) 1930, rok XLV, nr 23. Współczesne pielęgniarstwo polskie, Jego zadania i znaczenie (Contemporary Polish nursing, Its task and its importance), Bezpłatny dodatek do „Pielęgniarki Polskiej”, Kraków (Free supplement to „Polish Nurses”) 1937. www.wmpp.org.pl Zjazd Międzynarodowej Rady Pielęgniarek (Congress of the International Council of Nurses), „Pielęgniarka Polska” („Polish Nurse”) 1933, rok V, nr 1-2. [131] Marta Płaska - an outstanding scrub nurse Grażyna Gierczak ¹Center of Postgraduate Education for Nurses and Midwives, ² the Main Historical Commission at the Polish Nurses Association Main Board Introduction Marta Płaska was an outstanding scrub nurse whose work and activity in professional organizations influenced the development of modern surgical nursing. Aim The paper is to present the role-model nurse, manager and teacher of many generations of instrumenting nurses. Material and methods The study used the biographical method and the historical documents’ analysis technique. Results Marta Płaska became a model nurse who distinguished herself with enormous knowledge, exceptional professional skills, competence and extraordinary personality. After she received her diploma from the School of Nursing at the Hospital of the Transfiguration of Jesus in Warsaw, she was appointed to work in the First Surgical Clinic of the Infant Jesus Hospital in Warsaw. After that she worked as a scrub nurse. She was promoted quickly and after two years of working at the operating theatre she became a Ward Sister. She took part in many innovative and complicated operations. She assisted professor Nielubowicz in the first kidney transplantation in Poland in 1966. When the Clinic was moved to the newly built Hospital on Banacha street, she managed the general surgery unit. She introduced innovative solutions to improve the work of nurses. She shared her knowledge and experience with other colleagues. She was active in Polish Nurses Association (PNA) in many areas. She represented PNA at the Congress of International Council of Nurses (ICN) in Los Angeles in 1981. She participated in the humanitarian mission to Cambodia. Conclusions Marta Płaska was the leader in surgical nursing and contributed significantly to its improvement. She introduced many innovative solutions in the work of nurses and initiated the development of anaesthesiological nursing and postoperative care. Bibliography 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. Płaska M. Akta osobowe. Sygn. C-I/P-12. Centralne Archiwum Pielęgniarstwa Polskiego. Gierczak G. Marta Płaska - role model in the business development of modern nursing. Problemy Pielęgniarstwa / Nursing Problems. 2017;(3):238-242. doi:10.5603/PP.2016.0039. Dębowska H. Radość ratowania życia. Kurier Polski. 1977; 11: 3. Machińska M. Moje miejsce wśród chorych. Przyjaciółka. 1977; 27 (1528): 8. Niederle B. Praca pielęgniarki na sali operacyjnej. Warszawa: Państwowy Zakład Wydawnictw Lekarskich; 1960. 133-135. Koreywo M. Udane przeszczepienie. Pielęgniarka i Położna. 1966; 4 (90): 22-23. Seidler B. Batalia o życie. Warszawa: Państwowe Wydawnictwo Iskry; 1969. 7. Skrzypek R. Problemy i perspektywy przeszczepiania tkanek. Pielęgniarka i położna. 1966; 6 (92): 11. Skrzypek R. Właściwości narkozy. Pielęgniarka i położna. 1965; 8 (82): 7-8. Nielubowicz J. Ostre schorzenia jamy brzusznej. Warszawa: PZWL; 1958. 86-91. Płaska M. Środki dezynfekcyjne. Pielęgniarka i Położna. 1974; 1 (195): 10-11. Lipnicka I. Dzień w Kampuczy. Pielęgniarka i Położna. 1980; 11 (265): 26-29. Płaska M. Organizacja i technizacja pracy. Pielęgniarka i Położna. 1981; 1 (267): 29. Burgomaster J. Polish nurse visits MGM. Nursing Pulse of New England. 1981; 31: 1. Płaska M. XVII Międzynarodowy Kongres Pielęgniarek. Pielęgniarka i Położna. 1981; 10-11-12(276): 25-26. [132] The First Nurses: a comparative study following the career journeys of Ethel Gordon Fenwick’s contemporaries in two provincial UK cities 1880 – 1921. Val Wood1, Eileen Shepherd2 1 Independent, United Kingdom; 2Independent, United Kingdom Ethel Gordon Fenwick (1857-1947) was the first nurse to register in the UK in 1921. She is recognised for her long campaign to achieve nurse registration which culminated in passing of the Nurses Registration Act 1919 which led to the establishment of the General Nursing Council in 1920. Fenwick is usually associated with St Bartholomew’s Hospital, London, but she spent her formative years in the Nottinghamshire village of Thoroton. She started her nursing career at Nottingham children’s hospital before she moved to Manchester to undertake her adult training. Through an investigation of Fenwick’s early nursing career and the careers of her contemporaries in hospitals in Nottingham and Manchester Royal Infirmary, a pattern emerges that indicates greater autonomy and geographical movement of nurses to secure training and experience during this early period. A further impetus was the introduction of a voluntary register of nurses in 1890 by the Royal British Nurses’ Association which stipulated that individual applicants must complete three years of training. The research utilises qualitative data provided by the early nursing registers to build a significant picture of individual nursing careers. A comparative study has been used to explore similarities and differences between two provincial cities in the UK which were atypical in the way the hospital system and nurse training evolved in the late nineteenth and early twentieth century. Fenwick’s link to Nottingham and Manchester provides the frame for discussion during a centenary (1919-2019) which has focussed on her achievements and the passage of the Nurses Registration Act in the UK. To date there has been limited research into nursing history in provincial cities and this project allows for a reappraisal of Fenwick’s early nursing career and those of her contemporaries. Please contact the authors to recieve a copy of the papaer and PP presentation. Bibliography // [133] The Nurse and the Literature: the nurse in two Italian texts of the XVII century. Antonio Raschi1, Claudia Polidori2 1 CNR, Italy; 2Independent Scholar Introduction The Italian term for “nurse” (“infermiere”, or, in Medieval Italian, “infermiero” or “infermieri”) is found first in the Rules of Siena Hospital, in 1305, and appeared in several similar texts in the following centuries. Yet, the term does not seem to have been used in literature until the XVII century, when it appeared in two works, by Florentine authors, namely the comedy “La Fiera”, by Michelangelo Buonarroti the Young, and the mock-heroic poem “Il Malmantile Racquistato”, by Lorenzo Lippi. The analysis of the figure of the nurse, although of limited relevance, as represented in these texts, may give some insights about the perception of the nurse’s role in contemporary society. The “nurse” in the examined works La Fiera (“The Fair”), by Michelangelo Buonarroti the Young, was represented to celebrate Carnival at the court of the Granduke of Tuscany in 1619. With this play, which has been defined as a moral satire, Buonarroti’s intention was to “teach amusing”. The play was made up of 3642 verses, and the performance lasted for about 3 and a half hours, with a good success, although some episodes were considered as naughty, in particular a pregnant woman was put on the scene: Buonarroti’s view of mankind was in fact liberal and ironic, and this was difficult to accept, for some outstanding members of the Court. Subsequently, Buonarroti worked on the text for about 35 years, leading it to the mesmerizing length of 32.000 verses. It was published first in 1724 and reprinted in 1860. The Fiera is considered as a treasure-house of technical vocabulary, a literary source of technical terms associated with trades and professions, that might otherwise exist only in oral tradition. The action presents real characters (prisoners, notary, etc.), together with personifications of abstractions (poverty, industry, commerce, etc.) and is set in a square, where a fair takes place, enclosed by different buildings, among them a hospital (mainly a mental hospital, sheltering mads-for-love). Among the characters, we find the Doctor, the male and female nurse, the Judge, the auxiliary staff of the hospital, whose interactions enlighten the different professional and social roles. Here, some examples are given: The judge, visiting the hospital on behalf of the governor, inquires after the hospital’s organization asking the male nurse about the number of patients, the number of doctors, their reliability and dedication. The nurse complains about the scarce attention of some doctors, which are only present at lunchtime, and about the workload. The doctor relays on the nurse’s observations to diagnose and to define the therapy, in a sort of a briefing. The doctor asks also the female nurse to observe the symptoms, then to assist him while visiting a woman (probably pregnant), to avoid gossip. Later he makes jokes about her ignorance and the therapy she suggests. He calls her «Medichessa» and «meddler». The auxiliary staff does not interact with the important visitors, but complains about their presence. The Malmantile Racquistato («The Reconquered Malmantile) is a mock-heroic poem, a parody of epic poetry. The faint plot describes the conquest of Malmantile (a ruinous fortress near Florence) by the troops of General Baldone, who tries to reestablish the righteous reign of his cousin by overthrowing her usurper with the help of an army of lazy, cowardly soldiers. But the plot is, in fact, rather an excuse for jokes, idiomatic phrases, hints at local traditions. The author Lorenzo Lippi (1606-1665) was mainly a painter; he attended to the composition from 1644 until his death. The poem was published in 1688, under the name of Perlone Zipoli (anagram of the Author’s name); later, it was published again with the explanatory footnotes by Puccio Lamoni (=Paolo Minucci) and others, that give a heap of information about the Tuscan way of life of the XVII century. In the third canto a doctor is represented, aneedoticaly, as an ignorant aiming only at money. Facing a case of dysentery, he exposes odd theories, and creates a great confusion. Some terms, related to nursing, are found in an octave, here reported (translation by the Authors): “…….Vedendo poi che il flusso raccappella (come quello, che ha in zucca poco sale) Comincia a gridar: Guardia la padella: E quasi fosse quivi un ospedale, chiama gli astanti, gli infermieri appella, il cerusico chiede, e lo Speziale……” (Seeing then that the flow is beginning again (just as a block-head would do) Starts to shout: man on duty, the bedpan [134] And, as if it was in an hospital, He asks for the servants, the nurses he calls He asks for the surgeon, and the apothecary…). The footnotes do not explain the term “medico”, or “dottore”, probably because they are of common use. Explanations are given for the other terms referring to hospital workers: Guardia (man on duty), the bedpan: the man on duty is called when the patients need to empty their bellies Astanti: are those that attend to serve the patients Infermiere: Infermiere is called, in the hospitals, the one who controls that the patients are put in bed, after they have been taken to be dressed. Moreover, the infermiere takes note to have them visited by the Doctor; and he registers in the book of admittances and discharges, and in the book of the deceaseds. Discussion Since the translation of Aristotle’s «Poetic» in 1549, in which Comedy is scarcely discussed, a large debate arose about the theorization of Comedy, and several Authors wrote about it (Nardi, 2019). In XVII century, many comedies were written and performed, and, in the same century, mock-heroic poems became popular. They were satires mocking the common Classical stereotypes of heroic literature. Many of these texts were written aiming to a convivial enjoyment, and were read in specific circles, so large delays before publication, that took place after the death of the Authors, is not surprising (Di Santo, 2013). Even in the rules of Siena Hospital, written in 1305, a clear distinction is made between the “infermiere”, taking care of the organization, and the other figures (“servitori”) directly taking care of the patients’ needs. The same difference appears in the two examined texts. In Fiera, the judge refers to the nurse to get information about the hospital; and nurse feels free to joke about the scarce devotion to work of some doctors; the nurse is asked about the organization and is charged of expelling from the hospital those that have no reason to remain there. In addition, from the doctor’s words, it is clear that the nurse himself manages the interaction with the doctor (“as you have put me to take care of these beasts…”). To sum up, the nurse appears to have a responsibility position. On the other hand, the auxiliary staff has no relevant role in the action, and seems mainly interested in having a quiet life. The different role of the two categories is explicitly stated in the notes to the Malmantile, in which the “bureaucratic” role of the nurse is fully evidenced. The Nurse is literate, is responsible of registering the hospitalizations, and coordinates the activities of minor figures. The interaction between the doctor and the female nurse, as represented in the Fiera, opens different perspectives. The doctor asks her to be at his side while visiting a pregnant woman, but looks down on her therapeutic suggestions, and makes a fool of her. In fact, the Counter-reformation of the Catholic Church had forbidden women to practice medicine and healers were often suspected of witchcraft. The same hostile attitude is found in the first treatise of nursing published in Italy (Dal Bosco, 1664) that had a large diffusion for several decades. Buonarroti, in spite of his liberal views, had probably to confirm his adhesion to the Catholic point of view in front of the Court. The existence of other texts mentioning the nurse cannot be ruled out, and a more detailed research could lead to other interesting results. Bibliography 1. 2. 3. 4. 5. 6. Buonarroti, M. Il G. (1860) La Fiera-La Tancia, (ed. by Fanfani, P). Le Monnier, Firenze. Dal Bosco, F. (1664) La Prattica dell’Infermiero. Giambattista Merlo, Verona. Di Santo, L. (2013) L’eroicomico Fiorentino di Lorenzo Lippi. LED Edizioni Universitarie di Lettere Economia Diritto, Milano. Lippi, L. (1731) IL Malmantile Racquistato di Perlone Zipoli colle note di Puccio Lamoni e d’altri. Carlieri, Firenze. Nardi, F. (2019) Trattati, prologhi, lezioni. Teoria e pratica del comico tra Cinque e Seicento. In Magherini S., Nozzoli A., Tellini G. (Eds.) Le Forme del Comico. Società Editrice Fiorentina. Pellegrini, M (Ed.) (2005) La Comunità Ospedaliera di Santa Maria della Scala e il suo più antico Statuto. Pacini Editore, Ospedaletto, Pisa. [135] Conclusions And now we have come to the end. I hope you are all happy and satisfied with what you have seen (and this is not the end yet, as you have the tours in the afternoon), listened, encountered, read, experienced during these days. I believe these actual days have been “historical”. Speaking for myself, this has been a unique experience. The world of passionate historians, nurse historians, members of free associations, share common values, challenges and problems. We need a very high dose of motivation, dedication, endurance and, especially, tenacity. Tell me if I am wrong, but... I believe we do have many similarities with the personality and character of Miss Nightingale. We must have some part of it. We need it. Most of the nurses, matrons, nuns, saints, military nurses we have heard about here had something special. They have influenced the evolution and the history of hospitals, nursing, health care, home care, military nursing, touching in some way the lives of millions of people in every country. And I like to quote here the words of Pope Francis on the 4th of February during a special ceremony held in Abu Dhabi to remember the first anniversary of the signature of the Document on Human Fraternity for World Peace and Living Together. On that occasion, he said: “I greet all of you present, and I greet especially all the people in humanity who help their poor, sick, persecuted, and weak brothers and sisters, regardless of religion, color, or race. (...) Today we celebrate the first anniversary of this great humanitarian event, a better future for humanity, a future free from hatred, rancor, extremism, and terrorism, in which the values of peace, love, and fraternity prevail”. I think in our work we play our part, in these last few days we have play our part too, even if it is only a drop, a crumb in this troubled world where conflict often seems to prevail; we have made a difference with our solidarity and friendship. Each of us can make the difference, in big events, as well as in everyday life. I do not have the presumption to summarize in 5 minutes all the contents that have emerged in these three days of discussions, presentations and posters. I leave you with your reflections and thoughts for your way back home. I only tell you that I am dreaming another dream: a crowd-funding with the goal of systematizing the archive of the CNAI, the first lay association of nurses in Italy. I believe we have to transfer this legacy to future generations: young nurses must be able to know where they come from, who they have to thank for being university educated and members of a professional order. God willing, I will do my best to create synergies, seek help, pool interests and, as in the case of this Conference, this dream could also come true. I am looking forward to keep in touch with any of you that would love to come back to Florence or to Italy: as you know, we have such a rich historical and cultural heritage .... the only problem is to choose where to go first. Thank you again for coming, and have a good journey back home! Cecilia Sironi We started this great adventure with a warm and powerful CIAO and now, at the end we arrive to ARRIVEDERCI. Goodbye time. Spelling letter-by-letter ARRIVEDERCI means: Until + Again +See + Each Other or in a more comprehensible English: (So long) until we see each other again. It is a fitting goodbye whenever you send someone off who you care about. There is no definitive goodbye in Italy. Instead, you tell your friends that you hope to cross paths again soon. We all know how important the research is. The history is full of great works that have marked a turning point in the development of a branch of knowledge, and in which the proposals for a new theoretical frame of reference or a new systematization of the known facts were preceded by an extensive historical introduction consisting in the evolution of the topic up to that moment. However, this importance is directly proportional to the way this researches are divulgated. Seminars, workshops and symposia are very common and popular means of interactive fora in modern day business world. If used effectively, they can play a vital role in the dissemination of knowledge and build-up of skills. They facilitate intense deliberations through participation and interaction in an organized manner. Every researches knows that our work is filled with technical jargon, complex ideas and concepts that can be difficult to communicate to other scientists and even more difficult to the public on the whole. [136] The benefits of sharing data are immense: research findings can be validated through replication of studies or a new hypothesis may originate from the same dataset. Compare historical data and events and how these events have been experienced in each different country. The history of the world is not of just one culture, but many. On one hand, these cultures have interlinked transculturally with one another; on the other, they have also repeatedly disentangled themselves in that such links have dissolved or chafed against one another until they snapped. In the last three days, we just underline this concept, more than 22 countries spoke about a single person, Florence Nightingale, and we found a lot of connections and so many ideas for new studies together. This is what I really wish for all of us. Visit each other, reconnect with the colleagues all over the world, share, and help the nursing history keep alive and understandable to all customers, academics, student, nurses and patients, for everyone That why I am saying "arrivederci" instead of "bye”. I hope this congress will leave to all of us this Italian spirit -- "until we see each other again" welcoming you now and whenever you come back. Anna La Torre [137] Nightingale, Florence: Visions and Revisions Christine E. Hallett Introduction Florence Nightingale is widely recognised as one of the nineteenth century’s greatest polymaths, with expertise ranging from statistics to sanitary science; from social policy to religious mysticism. But the subject for which she is best known – nursing - is also that about which she is most often misunderstood. Nightingale was not only, herself, an experienced nurse, she was also one of the nineteenth centuries most prolific writers on the subject. From her apparently simple but ultimately ground-breaking manual, Notes on Nursing, through her circular letters written for her Nightingale School probationers, to official reports in which she offered recommendations to the governments of her day, Nightingale’s writings are voluminous and wide-ranging. In my efforts to decode their contents, I am indebted to literally dozens of Nightingale scholars, including biographers such as Mark Bostridge (2008), whose achievement in unpicking both hagiography and deliberate denigration is unsurpassed; nurse historians such as Carol Helmstadter (2002; 2003; 2009), who has enabled a better understanding of the context in which Nightingale’s work was produced; and meticulous empiricists such as Lynn McDonald (2001-2; 2010), whose sixteen-volume compilation of Nightingale’s writings has done so much to break open the vast field of Nightingale studies McDonald. But Florence Nightingale’s ideas – and, indeed, her ideals – can only really be understood through a close and detailed scrutiny of her own writings. But where to start? The corpus of Nightingale’s writings is vast. Even the student who attempts to analyse only on those texts that relate directly to nursing faces a daunting task. And this is, perhaps, why Nightingale has been so frequently misunderstood – this, and the tendency for some Nightingale scholars to fall into the twin traps of academic ambition and undue haste. A failure to focus on Nightingale’s own writings has, at times, resulted in the publication of ostensibly new findings that merely repeat old errors. If only to pass over his work as quickly as possible, I shall mention F. B. Smith (1982) at this point, along with the service that was done to nursing history by Lynn Macdonald’s careful (if rather outspoken) dismantling of his empirically ungrounded arguments. Beyond Smith’s obvious errors lies a community of historians – particularly medical historians – whose failure to understand Nightingale’s work on its own terms has translated into a series of misleading assertions that Nightingale’s ideas about health and disease (and most particularly about infectious diseases) were both ambiguous and confusing (Ackerknecht, 1948; Rosenberg, 1979; Vogel and Rosenberg, 1979; Bynum, 1994, p.188). This paper will reconsider Nightingale’s own works by relating them to the social, intellectual and spiritual context of her time. My contention is that, when taken in context Nightingale’s views on nursing were coherent, consistent and practical. In reconsidering Nightingale’s ideas – as expressed by herself – this paper will also revisit some of the Nightingale controversies, and, in doing so, it will suggest that Nightingale’s detractors failed to recognise both the consistency of her ideas and her capacity to adapt her thinking in response to the changing medical perceptions of her day. One means of understanding Nightingale’s ideas and ideals is to trace their origins in three influential currents of thought. The first is a peculiarly British, Victorian and Anglican belief in a divine plan that could only be implemented by godly human beings, or, in other words, the powerful current of thought embedded in Victorian culture that held that ‘God helped those who helped themselves’ – which mobilised around so-called ‘muscular Christianity’ (Ellisor, 2005). The second is a scientific milieu (at least among the middle classes) that encouraged members of the medical professions to theorise about the nature of disease (Hallett, 2005). In expounding on the concepts ‘health’ and ‘disease’, Nightingale in common with many of her medical contemporaries trod warily across the medical orthodoxies of her day, and has, in consequence been accused of reluctance in accepting the reality of infection, when in fact, she showed a remarkable percipience in warning against an unthinking adoption of ‘germ theory’. The third is what I might call a prototype feminism that draws in part upon earlier writings, such as those of Mary Wollstonecraft and Charlotte Bronte and which had a deep influence on the ways in which she shaped nursing as a profession for women (Nightingale, ed Strachey, 1928). Nightingale’s vision of humanity’s divine purpose Florence Nightingale was, famously, convinced that she had been ‘called by God’ at the age of 16, to serve humankind (Bostridge, pp.54-5). It had taken her many years first to find an outlet for the powerful urge to do ‘good works’ that followed that call, and then to persuade her family to permit her to pursue nursing. Following her initial experiences in Germany, Paris and London, and her famous expedition to the Crimea, she began to formulate her ideas in a succession of writings. An enforced illness following a serious and lifethreatening bout of Crimean fever – an illness which has convincingly been identified as the milk-borne infection, brucellosis – kept her confined to her rooms (often to her bed) (Young, 1995; Bostridge, 2008, p.282), an imprisonment which, paradoxically, liberated her to spend her time working out her philosophies of healthcare and social reform (Cook, 1913; Woodham-Smith, 1915; Huxley, 1975; Baly, 1997). In her Notes on Nursing, Nightingale drew upon her philosophy of human responsibility. “God lays down certain physical laws”, she retorted in her chapter on Health of Houses, adding, “Upon His carrying out such laws depends our responsibility… Yet we seem to be continually expecting that He will work a miracle, i.e. break his own laws expressly to relieve us of responsibility” (Nightingale, 1859, p.17). In a draft letter identified by Lynn McDonald as having been intended for her father, Nightingale set out her philosophy of God’s divine purpose for humanity: The same tie really connects us to every one of our fellows as the tie which connects us with God… To neglect or ill use the imbecile old woman, the dirty child, is the same crime of lese majeste against the Almighty that blasphemy of God is. I think that love to mankind ought to be our one principle in the Poor law – not philanthropy – philanthropy is the biggest humbug I know (Nightingale, ed McDonald, 2004, p.432 [139] In condemning philanthropy as the opposite of genuine reform, Nightingale identified the hypocrisy at the heart of Victorian society – a hypocrisy that enabled members of a wealthy and privileged governing elite to enhance their own egos – both individual and collective – without actually improving the lives of those they claimed to support. One of the greatest dilemmas Nightingale faced was in the realm of poor law nursing. She was determined to improve the lot of the sick poor, who, she commented were neither deserving nor undeserving, but simply unable to lift themselves out of poverty and deprivation, because of their ill-health. Her challenge was to find nurses for these helpless individuals. During the 1860s, when she was working closely with members of the British parliament on the reform the Poor Law, she speculated on the possibility of training pauper nurses. The difficulties to be overcome were manifold. It would be necessary to bring girls into poor law hospitals at the age of 16, when the poor law relinquished its responsibility for them, in order to prevent their social and moral “ruin”. But she considered 16 far too young for nurse training, and was very anxious about the danger that would be posed to these young and vulnerable girls by the presence in many civilian hospitals of medical students (who were notorious for their rowdiness and bad behaviour). In a draft letter to her close friend and confidant, Mary Jones, she expanded on these problems: employing pauper-nurses was rife with problems. Even if one could find someone capable of training them, along with the funds to support them, Nightingale’s unspoken fear was that they would be vulnerable to sexual exploitation (Nightingale, ed. McDonald, 2004, p.392). Nightingale’s writings on the reform of Poor Law infirmaries reveal a vision for social reform that was ahead of its time. Her perspective foreshadowed that of Beatrice and Sidney Webb in their Minority Report on the Poor Law, published in 1909 (McDonald, 2004, p.428) . Nevertheless, despite her best efforts to secure the provision of expert nursing for patients in Poor Law hospitals, the Metropolitan Poor Act (1857) was a disappointment, and Nightingale was left with only one option: to reform Poor Law nursing hospital-by-hospital – a laborious and often unsuccessful endeavour. Her first experiment, which was conducted with the financial and practical assistance of reformer, William Rathbone, involved the placing of the devout and self-sacrificing Agnes Jones at the head of a small group of nurses at the Brownlow Hill Infirmary in Liverpool. Jones struggled to bring order and efficiency to the chaos of the infirmary wards, dying in the attempt, and evoking an outpouring of admiration from Nightingale, whose best-known writing on Jones, Una and the Lion, was both a hagiographic account of the unnamed paragon (who had been so self-effacing that she had, in fact, asked not to be named) and a ‘call to action’ to other young women (Nightingale, 1868, pp. 360-66). Nightingale’s second experiment, the appointment of Elizabeth Torrance at the new Highgate Infirmary in 1868 was more successful in the longer term (McDonald, 2004, pp.428-9). Nightingale’s vision of the centrality of nursing in the care and cure of patients Nightingale expressed forthright views on the nature of disease, and the role of nursing in its eradication. In her well-known treatise, Notes on Nursing she declared that “all disease, at some period or other of its course, is more or less a reparative process, not necessarily accompanied with suffering: an effort of nature to remedy a process of poisoning or of decay”. Whilst in some ways quite singular, this view was not incompatible with the mindsets of mid-nineteenth-century medical scientists, who still adhered to the eighteen century medical teachings that any given episode of ill-health was caused be one of two processes: inflammation or putrefaction. Put simply, inflammation was understood as a mechanical failure of the circulation, and putrefaction was understood as a stagnation of body fluids. These closely-connected theories were seen as highly enlightened, having superseded the preceding views of medieval doctors that disease was caused merely by imbalance in four bodily fluids known as humours (Hallett, 2005). The mechanistic view of the “inflammationists” were particularly fashionable, and Nightingale’s view that disease was an adaptive process interlocked well with this perspective. Nightingale also had clear views on the nature of bodily symptoms, pointing out that these were not necessarily the consequences of disease processes, but more often, the result of the conditions under which individuals lived. Discomfort, she argued, was likely to be a consequence of “the want of fresh air, or of light, or of warmth, or of quiet, or of cleanliness, or of punctuality and care in the administration of diet, of each or of all of these” (Nightingale, 1859, p.2). But, she added, anomalies arising out of these lapses could rapidly become a process of poisoning or decay leading to disease. For today’s experts in health promotion her ideas have a strongly contemporary resonance, as if she was, somehow, ahead of her time. But such an interpretation is quite naïve: Nightingale’s thinking was immersed in the medico-scientific context of her day. Her focus on six cardinal health-giving principles - fresh air, light, warmth, rest, cleanliness and nutrition – arose out of her acceptance of theories of inflammation and putrefaction, rather than a foreshadowing of our modern focus on the supposed origin of diseases in organic lesions. In common with other nurse-leaders of her day, Nightingale was anxious to identify nursing as a profession very different from medicine, with its own peculiar emphases. Where the surgeon’s focus was repairing limbs and removing “external blockages”, and the physician’s medicine was designed to remove “internal blockages”, the work of the nurse was much more complex. Her job was to regulate both the external environment and internal condition of the patient to ensure that neither damage nor blockage ever happened, or, if it did, that nature was able to clear the condition. And this emphasis on enabling nature to restore health, along with an insistence that it would indeed do so, if the clinician merely provided the right conditions for it to proceed, was absolutely key to Nightingale’s philosophy. Fresh air, light, warmth, rest, cleanliness and nutrition were not cures; they were nature’s enablers, and therefore far more important than any medical treatment. It would be easy to assume that Nightingale’s obsession with patient-cleanliness was a consequence of prudishness or religious sensibility. In fact, her focus arose out of an awareness of the medical theories of her day. Since the mid-eighteenth century, dirt had been recognised as a cause of inflammation: one of the prime-movers of disease. But no one had been able to satisfactorily explain the link. The mechanism by which exposure to filth translated into the mechanical disruption of body functions had been a subject of speculation for at least 100 years before Nightingale began to write on the subject. One of her most intriguing claims was that her deep understanding of the link between dirt and disease was the result of both book-learning and personal experience, but that her personal experience was the more valuable of the two. In a letter to British MP, C.P. Villiers, she comments on the tendency for “dirty” nurses to [140] put patients into “dirty sheets” which have been tucked under the bed without being washed: “An old matron, like me”, she comments, “is well up to all these ‘dodges’. The undersigned hath herself unearthed, or unbedded [sic], five.. dirty clothes, tucked under the beds, when doctors proclaimed it ‘all right’. I have not been an old nurse for twenty years for nothing”. (Nightingale, ed. McDonald, 2004, p.413). The implication here is that doctors, for all their book-learning, cannot recognise the obvious – indeed glaringly obvious – dangers into which their patients are placed. In a letter to her nurses written in June 1897, Nightingale developed this notion that nursing was, essentially, an art which could not be learned from books (although the reading of books could supplement the artistry acquired and was necessary in order to ensure an intelligent approach to the work): Never let doctors have to say of us what they have said of some nurses: ‘She knows as many words as I do, but she does not know how to make a patient comfortable.’ … Nursing is in general made up of little things; little things they are called, but they culminate in matters of life or death (Nightingale, ed McDonald, 2009, p.872). One of the accusations levelled at Nightingale by medical historians is the suggestion that she rather truculently refused to accept the idea that infective microorganisms, referred to as ‘germs’ were the causative agents in many of the most common nineteenth-century diseases. This view has probably originated in a failure to read beyond Notes on Nursing, a book written in 1859, when germ theory was still a new and largely unproven theory. It was only after Robert Koch’s work in the 1880s that medical science adopted germ theory wholesale, and it was soon after this that Nightingale herself came to accept it. In Notes on Nursing, she ridiculed that idea that diseases were “separate entities which must exist, like cats and dogs”. (Nightingale, 1859, p.23) Yet, a close analysis of her later writing on this subject suggests that, once she had been made aware of the evidence, Nightingale not only accepted germ theory, but actually promoted it, particularly among her own students. In an 1897 circular letter to her probationers she advised: Let me note here, in passing, every year we know more of the great secrets of nursing. One is the aseptic… we have been eminently taught this aseptic by our doctors and surgeons in their operating theatres. We have to carry it out in our nursing. Septic means blood poisoning; antiseptic means using certain substances supposed to counteract blood poisoning. Aseptic means doing away with everything that can possibly produce blood poisoning. Aseptic means absolute cleanliness. A great doctor, a friend of mine, says, ‘Call it germs, bacillus or dirt, the treatment is the same, that is, cleanliness’ (Nightingale, ed. McDonald, 2009, p.871-2). More recently, it has become clear that even Nightingale’s earlier pre-germ-theory writings contained much common sense. In Notes on Nursing, she demonstrated considerable prescience, pointing out that a simplistic adherence to germ theory would lead to a tendency to offer apparently quick and simple answers to complex environmental questions. Her perspective was vindicated by the twentieth century’s reliance on “magic-bullets” such as antibiotics, rather than a sufficiently close attention to diet, housing and poverty – factors which - as Nightingale had pointed out – were the real generators of disease. In the 1850s Nightingale had pointed out how difficult it would be to employ good doctors and nurses if “germ theory” took hold of the collective consciousness: Does not the popular idea of ‘infection’ involve that people should take greater care of themselves than of the patient? That, for instance, it is safer not to be too much with the patient, not to attend too much to his wants? Perhaps the best illustration of the utter absurdity of this view of duty in attending on ‘infectious’ diseases is afforded by what was very recently the practice, if is not so even now, in some of the European lazarets – in which the plague-patient used to be condemned to the horrors of filth, overcrowding, and want of ventilation, while the medical attendant was ordered to examine the patient’s tongue through an opera-glass and to toss him a lance to open his abscesses with? True nursing ignores infection, except to prevent it… Wise and humane management of the patient is the best safeguard against infection. (Nightingale, 1859, p.24) Nightingale has been accused of being, essentially, a miasmatist – of adhering to an out-of-date philosophy of disease-causation. She certainly emphasised the need for fresh air, referring to it as “the very first canon of nursing”. Essentially, she argued that the air in a patient’s room must be “kept as pure as the external air, without chilling him”. Achieving this was no mean feat. A nurse had to be astute enough to determine the best way of airing the sick room: Even in admitting air into the patient’s room or ward, few people ever think, where that air comes from. It may come from a corridor into which other wards are ventilated, from a hall, always unaired, always full of the fumes of gas, dinner, of various kinds of mustiness; from an underground kitchen, sink, washhouse, water-closet, or even, as I myself have had sorrowful experience, from open sewers loaded with filth; and with this the patient’s room or ward is aired, as it is called – poisoned, it should rather be said. (Nightingale, 1859, p.6) Providing warmth was just as difficult, because “to attempt to keep a ward warm at the expense of making the sick repeatedly breathe their own hot, humid, putrescing atmosphere is a certain way to delay recovery or to destroy life”. (Nightingale, 1859, pp.8-9) In her philosophy of health and disease, both pure air and warmth were required to prevent both putrefaction and a “loss of vital heat by the patient himself”. (Nightingale, 1859, p.10), and to “carry off the effluvia” produced by the sick. (Nightingale, 1859, p.13). Light was also essential, she added, pointing out that its absence resulted in “scrofula, rickets etc, among the children”. Nightingale emphasised the need for pure water and good nutrition- both commodities very difficult to find for the nineteenth century’s sick-poor. She also pointed out that the feeding of helpless patients – a task that appeared so simple – was, in fact one of the most complex elements of the work. She commented, “that thousands of patients are annually starved in the midst of plenty, from want of attention to the ways which alone make it possible for them to take food” (Nightingale, 1859, p.50). In recognising the link between sleep and health, Nightingale was, perhaps, ahead of her time. Beyond this, she also identified the need for a restful environment and an attitude in the nurse that would promote quiet and calm. In one of her typically quirky statements, she condemned the wearing of crinolines by nurses, pointing out that “a nurse who rustles.. is the horror of a patient”. (Nightingale, 1859, p.36) [141] Nightingale’s vision of women’s role and purpose Among the charges levelled at Florence Nightingale during the late twentieth and early twenty first centuries are those of anti-feminism and race discrimination. Accusations of racism have been effectively dispensed with by scholars who have examined the empirical evidence relating to Nightingale’s relationship with Mary Seacole at Scutari. Mark Bostridge, Lynn McDonald and Carol Helmstadter have all demonstrated that Nightingale’s attitude to Seacole was both polite and cordial (Bostridge, 2008; McDonald, 2010; Helmstadter, 2019). They have further shown that Nightingale’s decision not to permit Seacole to provide nursing services in any of the Crimean War hospitals was based on her concerns about the moral probity of Seacole’s previous work in the Crimea. Nightingale may have been mistaken about the nature of Seacole’s hotel at Balaclava, but her wariness – in the light of the difficult political position in which the British government had placed her at Scutari – is entirely understandable (Helmstadter, 2010, 28-54). Charges of anti-feminism are more difficult to evaluate – until one realises just how entrenched were the patriarchal views of British Victorian society. An examination of some of Nightingale’s writings in the context of her own time has revealed what has been subsequently been identified as a powerful “proto-feminist” strain in her work. So, was Nightingale an “anti-feminist” or a “protofeminist”? A reading of her essay, Cassandra, provides persuasive evidence that she was a “feminist before her time”. Ray Strachey was so impressed by Cassandra that she included the entire work as an appendix to her history of the British “Women’s Movement”: The Cause. (Nightingale, ed. Strachey, 1928, pp.395-418) Cassandra is a highly personal work, revealing of Nightingale’s own struggles with her identity as an English Victorian lady. “Passion, intellect, moral activity - these three have never been satisfied in a woman”, she declared. (Nightingale, ed. Strachey, 1928, p.398). In one particularly revealing passage, she likened female intellect to light of the moon: Women often strive to live by intellect. The clear, brilliant, sharp radiance of intellect’s moonlight rising upon such an expanse of snow is dreary, it is true, but some love its solemn desolation, its silence, its solitude… But a woman cannot live in the light of intellect. Society forbids it. Those conventional frivolities, which are called her ‘duties’ forbid it… What are these duties (or bad habits)? – Answering a multitude of letters which lead to nothing, from her so-called friends, keeping herself up to the level of the world that she may furnish her quota of amusement at the breakfast-table; driving out her company in the carriage. And all these things are extracted from her by her family… What wonder, if wearied out, sick at heart with hope deferred, the springs of will broken, not seeing clearly where her duty lies, she abandons intellect as a vocation and takes it only, as we use the moon, by glimpses through her tight-closed window shutters?. (Nightingale, ed. Strachey, 1928, p.404) Cassandra is a controversial and avant garde text, in which Nightingale emphasises what she views as the suppression of all that is positive and energetic in the women of her time. She goes so far as to declare that “Christ, if He had been a woman, might have been nothing but a great complainer”. (Nightingale, ed Strachey, 1928, p.416). Her bitterness at attempts to suppress her own intellectual power is evident, as is her solution to the problem: she clearly views nursing the perfect outlet for her suppressed energies – and those of other Victorian women. Indeed, Nightingale, like many nurses and doctors of her day, saw nursing as peculiarly suited to the propensities and abilities of women. In her preface to Notes on Nursing she goes so far as to suggest that “every woman or at least almost every woman in England has, at one time or another of her life, charge of the personal health of somebody, whether child or invalid – in other words, every woman is a nurse” (Nightingale, 1859, Preface, p.v.). Nevertheless, she also asserts: “It has been said and written scores of times, that every woman makes a good nurse. I believe on the contrary, that the very elements of nursing are all but unknown”. (Nightingale 1859, p.2). clearly there was a huge distinction for Nightingale between being a “nurse” and being a “good nurse”. Nightingale’s deliberately feminine (as distinct from feminist) language is particularly apparent in her addresses to her own Nightingale School nurses. In a circular letter dated June 1897 she emphasised the healing power of “intelligent loving kindness”, adding that patients have “the right” to expect” nursing care which is infused with “kindness, consideration, gentleness, courtesy, refinement” (Nightingale, ed. McDonald, p.877). She also added, however that firmness of character must accompany such gentle qualities, illustrating the power of such firmness by pointing out how reformed nurses have transformed the ambience of workhouse infirmary wards: I will not go back to the time when, in the old workhouses, the favourite Sabbath amusement of the sick male wards was to shy their tin plates and cups at each other across the ward, and then send for the police and give each other into custody. In many an infirmary the policeman might have almost been called the night nurse. All that disappeared at once with the educated and trained nurse. She became the powerful policeman. She is the salt of the wards (Nightingale, ed. McDonald, p.874). Nightingale’s claims that nurses had, by 1897, completely transformed the social atmosphere of the workhouse infirmaries is, perhaps, slightly excessive, although there is evidence to support her claim that these hospitals were no longer the places of dread they had been in the mid nineteenth century (Fraser, 1976). What is, perhaps, most significant in this quotation, though, is the claim that the new, reformed nurse, exercised not only loving-kindness, but also the strength and personal power of a police officer: a strength sufficient to quell the dangerous riotousness of the nineteenth century hospital ward. Even more significant is that Nightingale so deliberately identified the origins of nursing character in both education and training. Nightingale was clearly in favour of women’s education, though she also clearly believed that the training of nurses could be dangerously tainted by too heavy a reliance on “book learning” to the neglect of hands-on skills and moral guidance: There is no doubt that this is a critical time for nursing. Will you have women, or will you have words? Which nurse best?... There appears to be some danger of our being suffocated with words, or our thinking that we can learn nursing in six ambulance classes. This is now so common a superstition – I can’t call it anything else – that circulars announcing such classes reach me continually. Nursing takes a whole life to learn. We must make progress in it every year. It takes five years, not of words, but of practice, to make a ward sister. There seems some danger that the twentieth century will be an age not of facts, but of enthusiasms without facts. (Nightingale, 1897) [142] It is in this wariness of “book learning” that later academics have found elements of what they see to be Nightingale’s prejudice against nurse-education and thus against education of women more generally. This, in turn, has fuelled modern debates about whether nurses should perform “menial tasks”. In a controversial footnote in Notes on Nursing, Nightingale gives detailed instruction on the emptying of “chamber utensils”: If a nurse declines to do these kinds of things for her patient, ‘because it is not her business’, I should say that nursing was not her calling. I have seen surgical ‘sisters’, women whose hands were worth to them two or three guineas a week, down upon their knees, scouring a room or hut, because they thought it otherwise not fit for their patients to go into . I am far from wishing nurses to scour. It is a waste of power. But I do say that these women had the true nurse-calling – the good of their sick first, and second only the consideration what it was their ‘place’ to do – and that women who wait for the housemaid to do this, or for the charwoman to do that, when their patients are suffering, have not the making of a nurse in them. (Nightingale, 1859, p.14) Yet, alongside Nightingale’s assertion that a nurse should not refuse to scrub floors if it were really necessary, is an emphasis on the ability to manage assistants and servants. The nurse, Nightingale pointed out, must possess the “art of multiplying herself”. Trying to do everything oneself (except in the type of emergency situation described above) would only result in poor work and a neglect of the patient (Nightingale, 1859, p. 25). In her 1897 lecture to her nurses, Nightingale offered a more considered definition of what nursing knowledge should entail: The patient is to us a threefold interest: the intellectual interest as a case, which requires the closest observation of facts, to be explained by the lecture and the clinical teaching; the moral interest, as a fellow creature to whom we must do, while under our care, either moral good or moral harm; the technical interest, whereby we learn what to do for the patient, and how to do it. (Nightingale, 1897, p.879) Nightingale’s perspective on the complexity of nursing – an art so complex that it could not be learned from a book, is clearly laid-out in her contribution to William Rathbones’ Sketch of the History and Progress of District Nursing. She argued that, The tendency is now to make a formula of nursing, a sort of literary expression. Now, no living thing can less lend itself to a ‘formula’ than nursing. Nursing has to nurse living bodies and spirits. It cannot be formulated like engineering. It cannot be numbered or registered like arithmetic or population. It must be sympathetic. It cannot be tested by public examinations, though it may be tested by current supervision. The nurse’s art cannot be made a formula any more than the painter’s. The great painter Fuseli was examined as to how he mixed his colours. ‘With brains, Sir,’ was his answer. The good nurse can often only answer, if examined how she nurses, ‘with brains and heart, Sir, and with training and practice. (Nightingale, 1890, p.822) Conclusion This paper has identified the underlying consistency and coherence in Florence Nightingale’s thinking, by focussing on three significant strands in her writings: muscular Christianity, nineteenth-century medical science, and proto-feminism. Although each of these strands was powerful, it was Nightingale’s capacity to capture them in one almost-impossibly encompassing vision of professional nursing that both opened-up previously unheard of possibilities for Victorian women and helped lay the foundations for a profession that would provide safe and compassionate patient care for the next two centuries. Although her work was very complex, Nightingale believed it was the outcome of a mission that had been revealed to her in a divine vision. This mission, she believed, was a very simple one: to relieve suffering and enhance care. In a letter dictated to her esteemed colleague, Dr. John Sutherland, around 1867, Nightingale set out her life’s work: My life is spent in trying to introduce a great reform in the care and management of the sick and suffering. This is my work. I have proclaimed it, written about it, advertised about, printed about, in short, I have done everything I can to lend it my name and influence. And, while I have done this, publicly, I have privately exhorted, advised and aided those who were willing to work in the same direction but did not happen to know the way so well as I do (Nightingale, ed. McDonald, 2004, p.434) Bibliography Ackerknecht, Erwin, “Anti-Contagionism Between 1821-1867”, Bulletin of the History of Medicine, 22, 1948: 568-93 Baly, Monica, Florence Nightingale and the Nursing Legacy (London, Whurr Publishers, 1997) Bostridge, Mark, Florence Nightingale: The Woman and Her Legend (London, Viking, 2008) Bronte, Charlotte, Shirley (London, Smith, Elder and Co., 1849) Cook, Sir Edward Tyas, The Life of Florence Nightingale (London, Macmillan and Co., 1913) Ellisor, Sarah, “Florence Nightingale’s Cassandra: The Prophet’s Predecessors and Descendants”, Unpublished MA Thesis, The University of Georgia, Athens, Georgia, 2005. Available at: getd.libs.uga.edu/pdfs/ellisor_sarah_p_200508_ma.pdf Fraser, Derek (ed.) The New Poor Law in the Nineteenth Century (London, Macmillan, 1976) [143] Hallett, Christine, “The Attempt to Understand Puerperal Fever in the Eighteenth and Early Nineteenth Centuries: The Influence of Inflammation Theory”, Medical History, 49 (1) 2005: 1-28 Hallett, Christine E., ‘Nursing 1830-1920: Forging a Profession’, in Anne Borsay and Billie Hunter (eds.) Nursing and Midwifery in Britain Since 1700 (London, Palgrave, 2012) Helmstadter, Carol, ‘From the Private to the Public Sphere: The First Generation of Lady Nurses in England’, Nursing History Review, 9 (2001): 127-40 Helmstadter, Carol, “Early Nursing reform in nineteenth-century London: a doctor-driven phenomenon”, Medical History, 46 (3) 2002: 325-350 Helmstadter, Carol, “’A Real Tone’: Professionalising Nursing in Nineteenth-Century London”, Nursing History Review, 11, 2003: 3-30 Helmstadter, Carol, “Shifting boundaries: religion, medicine, nursing and domestic service in mid-nineteenth-century Britain”, Nursing Inquiry, 16 (2) 2009: 133-143 Helmstadter, Carol, “Navigating the Political Straits in the Crimean War”, In Nelson, S. and Rafferty, A.M. Eds.) Notes on Nightingale: The Influence and Legacy of a Nursing Icon (Ithaca, Cornell University Press, 2010): 28-54 Helmstadter, Carol, Beyond Nightingale: Nursing in the Crimean War (Manchester, Manchester University Press, 2019) Helmstadter, C. and Godden, J. Nursing Before Nightingale (London, Routledge, 2011) Huxley, Elspeth, Florence Nightingale (London, Weidenfeld and Nicolson, 1975) Maggs, Christopher, The Origins of General Nursing (London, Coom Helm, 1983) McDonald, Lynn, The Collected Works of Florence Nightingale (Wilfrid Laurier University Press, Waterloo, Ontario, 2001-2012) McDonald, Lynn (ed.) Florence Nightingale on Public Health Care: Volume 6 of the Collected Works of Florence Nightingale (Waterloo, Ontario, Wilfrid Laurier University Press, 2004) McDonald, Lynn, Florence Nightingale: Extending Nursing: Volume 13 of the Collected Works of Florence Nightingale (Guelph University Press, Waterloo, 2009) McDonald, Lynn, The Crimean War; Volume 14 of the Collected Works of Florence Nightingale Ed. Lynn McDonald (Waterloo, Ontario, Wilfrid Laurier University Press, 2010) McDonald, Lynn, Florence Nightingale at First Hand (London, Continuum, 2010) McDonald, Lynn, ‘Florence Nightingale and Mary Seacole on nursing and health care’, Journal of Advanced Nursing, 2014, 70 (6): 1436-1445, doi: 10.1111/jan.12291 Nelson, Sioban and Rafferty, Anne Marie, Notes On Nightingale: The Influence and Legacy of a Nursing Icon (Ithaca, Cornell University Press, 2010) Nightingale, Florence, “Una and the Lion” Good Words, 1 June, 1868): 360-66. Draft quoted in: Lynn MacDonald (ed.) Florence Nightingale on Public Health Care: Volume 6 of the Collected Works of Florence Nightingale (Waterloo, Ontario, Wilfrid Laurier University Press, 2004): 290-301 Nightingale, Florence, Letter to C.P. Villiers or H.B. Farnall, Boston University 2/7/2, In Lynn MacDonald (ed.) Florence Nightingale on Public Health Care: Volume 6 of the Collected Works of Florence Nightingale (Waterloo, Ontario, Wilfrid Laurier University Press, 2004) Nightingale, Florence, Draft Letter in Dr Sutherland’s hand, ADD MSS 45800 204-05. In: Lynn McDonald (ed.) Florence Nightingale on Public Health Care: Volume 6 of the Collected Works of Florence Nightingale (Waterloo, Ontario, Wilfrid Laurier University Press, 2004): 434 Nightingale, Florence, “Address 13: To the Nurses and Probationers Trained under the ‘Nightingale Fund’”, Florence Nightingale Museum 1.0277.1, In Lynn McDonald, Florence Nightingale: The Nightingale School: Volume 12 of the Collected Works of Florence Nightingale (Waterloo, Ontario, Wilfrid Laurier University Press, 2009): 872 Nightingale, Florence, Cassandra, In Strachey, Ray, The Cause: A Short History of the Women’s Movement in Great Britain (Bath, Cedric Chivers, 1928): Appendix 1, pp 395-418 [144] Nightingale, Florence, Undated draft in Dr. Sutherland’s hand for letters to Mary Jones and Dr. Henry Acland, ADD MSS 45786 ff17274, In Lynn MacDonald (ed.) Florence Nightingale on Public Health Care: Volume 6 of the Collected Works of Florence Nightingale (Waterloo, Ontario, Wilfrid Laurier University Press, 2004): 392 Nightingale, Florence, Incomplete draft of letter, probably to W.E. Nightingale. ADD MSS 45790 ff 358-9, In: Lynn MacDonald (ed.) Florence Nightingale on Public Health Care: Volume 6 of the Collected Works of Florence Nightingale (Waterloo, Ontario, Wilfrid Laurier University Press, 2004): 432 Nightingale, Florence “Introduction to the History of Nursing in the Homes of the Poor”, In William Rathbone, Sketch of the History and Progress of District Nursing from Its Commencement in the Year 1859 to the Present Date (London, Macmillan, 1890) Draft. In McDonald, Lynn, Florence Nightingale: Extending Nursing (Guelph University Press, Waterloo, date), pp.821-2 Rosenberg, Charles, “Florence Nightingale on Contagion: The Hospital as Moral Universe”, In Rosenberg, Charles, (ed.) Healing and History: Essays for George Rosen (New York, Science History, 1979) Smith, F.B. Florence Nightingale: Reputation and Power (London, Croom Helm 1982) Vogel, Morris and Rosenberg, Charles, The Therapeutic Revolution: Essays in the Social history of American Medicine (Philadelphia, University of Pennsylvania Press, 1979) Wollstonecraft, Mary, A Vindication of the Rights of Woman: With Strictures no Political and Moral Subjects (Boston, Thomas and Andrews, 1792) Woodham-Smith, Cecil, Florence Nightingale, 1820-1910 (London, Book Club Associates, 1972; first published 1915) Young, D.A.B. “Florence Nightingale’s Fever”, British Medical Journal, 311 (1995): 1697-1700 [145] The EFN Lobby at the EU & The Legacy of Florence Nightingale EU Member States Prof Dr Paul De Raeve, EFN Secretary General Candidate countries and potential candidates ❖150 years ago, she was the first to foster patient empowerment – encouraging patients to be the managers of their own health – people-centred healthcare ecosystems EU priority – European Social Pillar. ❖ She is also known for her political engagement - working behind-the-scenes for the nursing profession, to improve sanitarian conditions and for women’s rights. ❖ Most of her legacy is what EFN is still fighting for at the EU level today. Nightingale’s legacy in the EFN’s daily work Nightingale’s legacy EFN’s work She wanted nurses to be better educated and with more advance training. Reviewing Art 31 (Annexe V) from the EU Dir. stablishing the minimum standards for nurses’ education. She saw in nursing the necessity to know illness but also health to prevent diseases. Basis to prevention that the EFN is working hard to get on EU’ priorities. She pathed patients into managing their own health The EFN is promoting patient centred healthcare systems in the EU. She had great political involvement to change laws (sanitarian conditions army). The political representation of nursing is the main pillar of the EFN’s work. CPD - European Quality Assurance Register Min entry requirement – different pathways to become an EU Nurse European Professional Card – 4.600 hours AND PQD Directive Internal Market Information System at least 3 years Topics to be updated in Annexe V - Delegated Acts At least 33% theoretical and 50% clinical training on a fulltime basis – 2300 clinical stage!!! Competency list in Art 31 Safeguarding quality = Same ending product = One EU Nurse COMPETENCIES (ART 31) 1. To independently diagnose the nursing care required using current theoretical and clinical knowledge and to plan, organise and implement nursing care when treating patients; 2. To work together effectively with other actors in the health sector, including participation in the practical training of health personnel; 3. To empower individuals, families and grous towards healthy lifestyles and self-care on the basis of the knowledge and skills acquired; 4. To independently initiative life-preserving measures and to carry out measures in crises and disaster situations; Competencies in line with the EFN Competency Framework agreed by 35 National Nurses Associations COMPETENCIES (ART 31) 5. To independently give advice to, instruct and support persons needing care and their attachment figures; 6. To independently assure quality of and to evaluate nursing care; 7. To comprehensively communicate professionally and to cooperate with members of the other professions in the health sector; 8. To analyse the care quality to improve the own professional practice as a general care nurse. Competencies in line with the EFN Competency Framework agreed by 35 National Nurses Associations MODERNISED DIRECTIVE 2013/55/EU Needed to be Implemented by all MS on 18 January 2016 BUT Infringement Procedures started in 2017 – NON COMPLIANCE EFN support for implementation: EFN Competency Framework EFN COMPETENCY FRAMEWORK Independently Communication Leadership & Research Autonomy & Collaboration Empowerment Prevention & Health Promotion Teamwork – Leading Team NURSES GOING ABROAD Regulated Professions Database: http://ec.europa.eu/growth/tools-databases/regprof/ Mobility of Nurses Ranking of most mobile professionals (1997 – 2016) EU Commission data – 6 of 10 Health professionals Nightingale’s legacy in the EFN’s daily work Nightingale’s legacy EFN’s work She wanted nurses to be better educated and with more advance training. Reviewing Art 31 (Annexe V) from the EU Dir. stablishing the minimum standards for nurses’ education. She saw in nursing the necessity to know illness but also health to prevent diseases. Basis to prevention that the EFN is working hard to get on EU’ priorities. She pathed patients into managing their own health The EFN is promoting patient centred healthcare systems in the EU. She had great political involvement to change laws (sanitarian conditions army). The political representation of nursing is the main pillar of the EFN’s work. Proportionality Directive INCLUSION HCP!! Protect nursing from being downgraded! Any new or amended regulation shall be based on proper public health justifications. Regulation of purely economic nature or purely administrative reasons cannot be used as justifications by national governments. 20 Principles The Nurses’ Voice European Federation of Nurses Associations EUROPEAN PILLAR OF SOCIAL RIGHTS 4 of interest for nurses: • Principle 16 - Healthcare • Principle 6 – Wages • Principle 1 – Education – More save! • Principle 18 – Long-term care EFN Workforce Matrix 3+1 3 Categories General care nurse – DIR55 +1 Specialist nurse Advanced Nurse Practitioner • The future principles for the development of Health Care Assistants PUTTING A HUMAN FACE TO POLICYMAKING DIRECTIVE SHARP INJURIES Directive on the Prevention from Sharp Injuries in the Hospital and Healthcare Sector (2010/32/EU) Aim: To protect Europe’s healthcare professionals and workers from potentially dangerous infections due to injuries with needles and other sharp medical instruments. Implementation is important! EU ENLARGEMENT Transposition of Acquis Communautaire Implementation of basic principles of the EU TREATY LIBERTY, DEMOCRACY, HUMAN RIGHTS and FUNDAMENTAL FREEDOMS (free movement) 1st to 6th wave of EU enlargements – Next Wave? EU ENLARGEMENT Acquis Communautaire – 36 Chapters on EU Responsibility Sectors Comparability between national legislation and EU rules – evaluated in each chapter Support from the EC – TAIEX peer reviews, workshops and capacity building seminars Free movement of people & removal of obstacles to provide services – Chapter 3 – Directive 2005/36/EC This enables MS to recognise professional qualifications gained in another MS. • SUPPORTING EFN MEMBERS IN ACCESSING EUROPEAN FUNDS • More money needs to be directed to the healthsector, towards nursing research Horizon Europe is the new research and innovation programme that will succeed Horizon 2020. The European Commission has proposed for it 100€ bn, as part of the EU's proposal for the next EU longterm budget, the multiannual financial framework (MFF). WHAT IS A GOOD PROPOSAL? Criteria for evaluation Excellence Impact Implementation – KPIs The EU’s current leadership The European Parliament The European Council and the Council “Voice of the people” “Voice of the Member States” David SASSOLI, President of the European Parliament The European Commission “Promoting the common interest” Ursula VON DER LEYEN, President of the European Commission Charles MICHEL, President of the European Council The Council of the EU The European Commission The European Parliament GET IN TOUCH Clos du Parnasse, 11A - 1050 Brussels Tel: +32 (0)2 512 74 19 Fax: +32 (0)2 512 35 50 Email: efn@efn.be Web: www.efnweb.eu Twitter: @EFNBrussels Facebook: /EFNBrussels

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