2. History of Nursing Ireland

4. Who were.. the first the first‘nurses’?

5. Throughout the middle ages, care was provided primarily by religious orders to sick and poor Throughout the middle ages, care was provided primarily by religious orders to sick and poor Some of the earliest nurses were nuns. Some of the earliest nurses were nuns. Sisters of Mercy order originated in 1830s by Roman Catholic Church in Dublin (still exists today) Sisters of Mercy order originated in 1830s by Roman Catholic Church in Dublin (still exists today)

6. No specific training was required for someone to become a nurse No specific training was required for someone to become a nurse Wealthy individuals received care at home by doctors Wealthy individuals received care at home by doctors During the Middle ages continued…

7. Besides nuns, other early nurses included: Women of ill repute Women of ill repute Poor, single women with no family or hope of marriage Poor, single women with no family or hope of marriage Prisoners, servants and slaves Prisoners, servants and slaves

8. Nursing prior to the late 1800s: Required no specialized training Required no specialized training Paid badly, if at all Paid badly, if at all Was considered unrespectable Was considered unrespectable Carried out under deplorable conditions Carried out under deplorable conditions Was NOT regarded as A profession Was NOT regarded as A profession Often did little to help patients recover Often did little to help patients recover

9. Nursing as a profession Emerged in late 19 th century Emerged in late 19 th century Credit is given to Florence Nightingale Credit is given to Florence Nightingale

10. Who was Florence Nightingale? She was born in 1820 and died in 1910 She was born in 1820 and died in 1910 Born in Italy to wealthy English parents Born in Italy to wealthy English parents Frustrated by lack of options for women of her social background Frustrated by lack of options for women of her social background Defied parents and society and traveled to Germany and throughout Europe to train as a nurse Defied parents and society and traveled to Germany and throughout Europe to train as a nurse Her big opportunity came when the Crimean war broke out in 1854 Her big opportunity came when the Crimean war broke out in 1854

11. During Crimean War: Secretary of War asked her to go take charge of the hospital at Scutari in Turkey. Secretary of War asked her to go take charge of the hospital at Scutari in Turkey. Nightingale showed up with 38 trained nurses and faced a death rate of 40% Nightingale showed up with 38 trained nurses and faced a death rate of 40% She was met by patients lying on boards among piles of filth, patients received only one meal a day, no supplies, no sanitation, and hostility from army doctors She was met by patients lying on boards among piles of filth, patients received only one meal a day, no supplies, no sanitation, and hostility from army doctors

12. Her accomplishments at Scutari in two years included: Death rate decreased to 2% Death rate decreased to 2% She established cleanliness and sanitation rules She established cleanliness and sanitation rules Patients received special diets and plenty of food Patients received special diets and plenty of food Improved water supply Improved water supply Patients received proper nursing care Patients received proper nursing care Nightingale established a reputation which allowed her to improve nursing standards at home Nightingale established a reputation which allowed her to improve nursing standards at home

13. Florence Nightingale Nightingale established nursing school at St. Thomas’ Hospital, London upon return Nightingale established nursing school at St. Thomas’ Hospital, London upon return By 1887, Nightingale had her nurses working in six countries and U.S. By 1887, Nightingale had her nurses working in six countries and U.S. Nightingale developed basic philosophy re: the profession of nursing different from other existing programs Nightingale developed basic philosophy re: the profession of nursing different from other existing programs Nightingale was a nurse, philosopher, statistician, historian, politician and more Nightingale was a nurse, philosopher, statistician, historian, politician and more Today Nightingale is considered the founder of modern nursing Today Nightingale is considered the founder of modern nursing

14. Nightingales ‘7’ basic tenets were that: 1. The content of nursing education must be defined by nurses. 1. The content of nursing education must be defined by nurses. 2. Nurse educators are responsible for the nursing care provided by students and graduates of the nursing program. 2. Nurse educators are responsible for the nursing care provided by students and graduates of the nursing program. 3. Educators should be trained nurses themselves. 3. Educators should be trained nurses themselves. 4. Nursing schools should be separate entities, not connected with physicians or hospitals. 4. Nursing schools should be separate entities, not connected with physicians or hospitals.

15. Nightingale’s Basic tenets continued.. 5. Nurses should be prepared with advanced education and should engage in continuing education throughout their careers. 5. Nurses should be prepared with advanced education and should engage in continuing education throughout their careers. 6. Nursing involves both sick nursing and healthy nursing and includes the environment as well as the patient (holism). 6. Nursing involves both sick nursing and healthy nursing and includes the environment as well as the patient (holism). 7. Nursing must include theory. 7. Nursing must include theory.

16. Uniforms Caps And other Traditions

17. Characteristics of a Good Nurse!  Whilst recognizing the occasional utility of a man as a nurse, we are inclined to think that the occupation is one which is most safely left in the hands of women  Tall and strong, who has a certain suppleness of movement. One accustomed to play lawn-tennis, who can run, and skate, and row, makes the best material.  If she can dance, especially if she is an enthusiastic dancer, it is a great advantage.  If in addition to being well formed she is favored with good looks, it is all in her favors, for doctors readily recognize the influence of an attractive person in the management of refractory patients.  What do you think?

18. Education  If the doctor will teach, and the pupil is intelligent and willing, a very serviceable nurse may be improvised in a few hours.  There is not particular mystery about nursing and the technicalities are easily acquired.

19. Age Requirements  Twenty one is a good age to begin and forty is a good age at which to retire.  A women is much older than a man at the age of forty, and by that time a woman should have made some permanent provision in life for herself. Few doctors will employ old nurses, and few patients care to have them.

20. Caps  Caps were originally large to cover most of head to keep hair neat  Cap and aprons signify respectability, cleanliness and servitude  Later became symbolic of recognition of achievement  Capping ceremony

21. Uniforms

22. Uniforms  Uniform symbolic of servant  Uniform sign of respectability  “She should be always always quietly dressed….even off duty, qaudy ribbons and showy feathers do not become those”

23. Brief history… Some opposition by doctors Some opposition by doctors “Will not be content until executives…” (Abel- Smith) “Will not be content until executives…” (Abel- Smith) Nursing had changed from an occupation for servants to a “vocation” for upper classes Nursing had changed from an occupation for servants to a “vocation” for upper classes End C19th- all voluntary hospitals England had schools of nursing End C19th- all voluntary hospitals England had schools of nursing

24. Towards registration 1902 Registration of Midwives Act 1902 Registration of Midwives Act England and Wales only England and Wales only Central Midwives Board Central Midwives Board 1919 Nurses’ Registration Act 1919 Nurses’ Registration Act Very interesting developments/debates prior to this Very interesting developments/debates prior to this Statutory register Statutory register General Nursing Council General Nursing Council

25. Irish history of nursing 1718 Jervis Street Hospital 1718 Jervis Street Hospital 1733 Dr Steeven’s Hospital 1733 Dr Steeven’s Hospital 1734 Mercer’s Hospital 1734 Mercer’s Hospital 1744 Hospital for incurables (Donnybrook) 1744 Hospital for incurables (Donnybrook) 1745 Rotunda Lying-in Hospital 1745 Rotunda Lying-in Hospital 1753 Meath Hospital 1753 Meath Hospital 1757 St Patrick’s Hospital for the Insane 1757 St Patrick’s Hospital for the Insane

26. Nurse training in Ireland No nurse preparation until over 100 years after first hospital founded No nurse preparation until over 100 years after first hospital founded Nightingale applied to go to St Vincent’s Hospital for nursing experience in 1844 and 1852- Just visited Nightingale applied to go to St Vincent’s Hospital for nursing experience in 1844 and 1852- Just visited 1834- First training programme to nurses- St Vincent’s Hospital- Irish Sisters of Charity 1834- First training programme to nurses- St Vincent’s Hospital- Irish Sisters of Charity Training for non-religious late 1850s Training for non-religious late 1850s By 1894- 39 hospitals had training schools By 1894- 39 hospitals had training schools Nursing probationers Nursing probationers 1-4 years training 1-4 years training

27. Key dates for nursing in Ireland in C20th 1919- Irish Nurses Association, then 1935 Irish Nurses’ Union (later Irish Nurses Organisation 1944, now Irish Nurses & Midwives Organisation 2010) 1919- Irish Nurses Association, then 1935 Irish Nurses’ Union (later Irish Nurses Organisation 1944, now Irish Nurses & Midwives Organisation 2010) 1920- first regulation of general (& mental health) nurses- General Nursing Council for Ireland 1920- first regulation of general (& mental health) nurses- General Nursing Council for Ireland 1950 Nurses’ Act 1950 Nurses’ Act

28. Key dates for nursing in Ireland in C20th

29. 1950- Nurses’ Act An Bord Altranais founded (GNC and CMB) An Bord Altranais founded (GNC and CMB) self-regulation? (Doctor as Chairperson until 1978) self-regulation? (Doctor as Chairperson until 1978) 1978 J Barlow (Midwife, Corporation councilor) 1978 J Barlow (Midwife, Corporation councilor) Divisions of register Divisions of register RGN, RGN (M), RM, RSCN, RIDN (Infectious diseases), RSN (sanatorium) (and post-registration divisions for tuberculosis and orthopaedic nursing) RGN, RGN (M), RM, RSCN, RIDN (Infectious diseases), RSN (sanatorium) (and post-registration divisions for tuberculosis and orthopaedic nursing) Training took 3 years in all divisions except midwives & Infectious Diseases took 2 years Training took 3 years in all divisions except midwives & Infectious Diseases took 2 years

30. 1950- 1985 1959- first training for “mental handicap” nurses 1959- first training for “mental handicap” nurses 1964 Registered Nurse Tutor division 1964 Registered Nurse Tutor division 1979 Registered Midwifery Tutor 1979 Registered Midwifery Tutor 1979 EEC Directives (mutual recognition, general training extended) 1979 EEC Directives (mutual recognition, general training extended)

31. 1980 Working Party Report 1980- Report of Working Party on General Nursing 1980- Report of Working Party on General Nursing met from 1975 met from 1975 matron-> director of nursing matron-> director of nursing fitness to practice committee (1986) fitness to practice committee (1986) live register, annual registration (from 1987) live register, annual registration (from 1987) An Bord Altranais should establish a fitness to practise committee to advise, admonish or censure nurses and, in the last resort, remove a nurse from the register An Bord Altranais should establish a fitness to practise committee to advise, admonish or censure nurses and, in the last resort, remove a nurse from the register

32. 1985- Nurses’ Act- new Board Implemented Report’s recommendations Implemented Report’s recommendations Central applications board/bureau Central applications board/bureau Objections from hospitals. Objections from hospitals. Established in 1987 but stalled. Established in 1987 but stalled. 1988- Bureau as “clearing house”- also stalled 1988- Bureau as “clearing house”- also stalled Commission- recommended new Board structure- awaiting legislation Commission- recommended new Board structure- awaiting legislation New Board elected in 2007 New Board elected in 2007

33. Nurse education... Pilot diploma pre-registration course in UCG/MHB 1994 Pilot diploma pre-registration course in UCG/MHB 1994 Nursing Applications Centre- centralised Nursing Applications Centre- centralised Separate scheme for “mental handicap” nursing applicants 1990 onwards Separate scheme for “mental handicap” nursing applicants 1990 onwards 1998- pre-registration diplomas in all schools of nursing 1998- pre-registration diplomas in all schools of nursing 1998- Nursing Careers Centre- work of NAC, promote nursing as a career 1998- Nursing Careers Centre- work of NAC, promote nursing as a career

34. Nurse education... Commission on Nursing Final report 1998 Commission on Nursing Final report 1998 recommended CAO for administration of entry process recommended CAO for administration of entry process 4 year pre-registration degree by 2002 4 year pre-registration degree by 2002 2000 Nursing Education Forum to manage transition 2000 Nursing Education Forum to manage transition 2002- 1st degree pre-registration nurses commenced education 2002- 1st degree pre-registration nurses commenced education

35. Other recent developments Scope of Nursing and Midwifery Practice Framework (2000) Scope of Nursing and Midwifery Practice Framework (2000) principles underpinning decisions about scope of practice principles underpinning decisions about scope of practice nurse/midwife’s accountability in determining competence nurse/midwife’s accountability in determining competence basis for expansion of practice basis for expansion of practice

36. Nurse and Midwife prescribing Legislative framework in place Legislative framework in place Now being implemented Now being implemented “Registered Nurse Prescriber” “Registered Nurse Prescriber” Specific certificate education involved; Specific certificate education involved; Protocol based; organisational policies Protocol based; organisational policies Involves An Bord Altranais, National Council, HSE Involves An Bord Altranais, National Council, HSE

37. National Council National Council for the Professional Development of Nursing and Midwifery National Council for the Professional Development of Nursing and Midwifery Established in January 2000 (recommended by Commission) dissolved in 2011 Established in January 2000 (recommended by Commission) dissolved in 2011 Clinical career pathways Clinical career pathways Clinical Nurse/Midwife Specialist Clinical Nurse/Midwife Specialist Advanced Nurse/Midwife Practitioner Advanced Nurse/Midwife Practitioner Continuing education for registered nurses- development, funding Continuing education for registered nurses- development, funding

38. Above topics covered in later lectures in more detail…. Particular developments/issues for 3 branches of nursing Particular developments/issues for 3 branches of nursing Commission on Nursing, An Bord Altranais, National Council Commission on Nursing, An Bord Altranais, National Council Health policy and health services Health policy and health services Health strategies Health strategies Role of the nurse within multi-professional teams/ within services Role of the nurse within multi-professional teams/ within services

39. References An Bord Altranais (2012) Collaborative Practice Agreement (CPA) for Nurses and Midwives with Prescriptive Authority. Dublin Stationery Office An Bord Altranais (2000) The Code of Professional Conduct for each Nurse and Midwife. Dublin Stationery Office. Government of Ireland (2000) A Strategy for a pre registration Nursing education degree programme. Nursing Education Forum. Dublin: Stationary Office Robins J. (2000) Nursing and Midwifery in Ireland in the Twentieth Century. Dublin: An Bord Altranais

40. References Scanlan P. (1991) The Irish Nurse. A Study of Nursing in Ireland: History and Education 1718-1981. Drumlin Publications Ltd. Manorhamilton. http://www.irishstatutebook.ie/1999/en/si/0376. html http://www.irishstatutebook.ie/1999/en/si/0376. html http://www.irishstatutebook.ie/1999/en/si/0376. html http://www.irishstatutebook.ie/1999/en/si/0376. html http://www.nursingboard.ie http://www.nursingboard.ie http://www.nursingboard.ie