Nursing is taking care of the physically or mentally sick, and looking after covalescents or those who cannot take care of themselves. If we put it this way it is clear that nursing does not have to be a profession. Indeed, in earlier times no professional education was needed to become a nurse. Nowadays, however, nurses receive a very professional training for about four years and, as with the rest of the medical profession, there are many possibilities to specialize in particular fields of medicine such as children’s disorders, geriatrics, dentistry, mental health, and so on.
Nursing the ill and wounded was a feature of many ‘primitive’ cultures. The ancient cultures of Egypt and Greece knew about the importance of body care, and established the relationship between food control and the prevention of certain infections. In the first centuries AD nursing became a religion-related occupation, in which altruistic Christians took care of ostracized groups such as lepers or sufferers from bubonic plague. The title ‘Sister’ for a nurse is derived from the times of religious nursing. After about the twelfth century AD the lay man started taking care of the sick; first of the nobility and later on also of ordinary people. Nursing guilds were founded at this time, such as the Order of Saint John, the Order of Saint Lazarus and the organization of cell brothers and sisters, who specialized in contagious diseases.
Some of these orders still exist. Until the sixteenth century nursing was of a high standard, but then there was a period of deterioration. Religious upheavals, during the Reformation period, became the first concern of the religious and nursing as a consequence was neglected and suffered, falling into the hands of poorly qualified people.
When in the nineteenth century revolutionary discoveries in medical science were made, it became clear that hygiene and health were closely related. Nursing became a professional occupation again.
Florence Nightingale (1820-1910) is known as the ‘mother of nurses’. She brought military nursing up to a high standard after being sent to the Crimea in charge of 38 nurses. Her nickname ‘lady of the lamp’ dates from the Crimean War period (1854-1856). Florence Nightingale organized in 1860 the first professional training for nurses, and also training for community nurses. She was instrumental in creating the high standards of the training, and in introducing salaries for nurses. To pay a salary was to be able to demand certain standards she maintained. She summed up her definition of nursing in ‘Notes’ (1859): ‘I use the word nursing for want of a better. It has been limited to signify little more than the administration of medicines and the application of poultices. It ought to signify the proper use of fresh air, light, warmth, cleanliness, quiet, and the proper selection and administration of diet – all at the least expense of vital power to the patient.’ Florence Nightingale’s birthday, May 12, was in 1965 proclaimed by the International Council of Nurses as international nursing day.
Nursing can be an extremely satisfying, if demanding, career; but potential applicants should be well informed of what it involves. The hours may be long and irregular, the work physically exhausting and the salary, especially to begin with, lower than most other professions that require an equally lengthy training. In short, a nurse needs to be dedicated to her job. In addition, she must be prepared to work as part of a team, while at the same time be able to use her own initiative. To become a professional nurse usually takes four years of in-service training. Periods of instruction in the theory of, among other subjects. Anatomy, physiology, pathology, hygiene and nursing, alternate with longer periods of training on the job under the supervision of a special training nurse. Each year the responsibilities of nurses become greater and graduation is completed only after a lot of exams on medical theory, writing case studies and taking tests on nursing skill. After graduation a nurse is sworn in, just like a doctor. The intimate nature of this profession requires an oath of silence on confidential information.
For a nurse it is possible – again just like a doctor – to specialize in some field of nursing. The obstetric nurse is specialized in everything concerning labour and birth, the delivery room, antenatal monitoring, and the special demands the maternity ward make, both technically and psychologically. The paediatric nurse, who cares for children, generally follows a special training course of one year in a paediatric hospital. Taking care of very sick children is something not every person can do. More technical fields of nursing are assisting in the operating room, intensive care unit and emergency or accident unit. Special emphasis is placed in training on sterile procedures, surgical instruments, monitoring body functions, checking fluid balances and dressing wounds.
These specialized branches of nursing may be technically very rewarding, but less so in terms of patient contact. Most patients these nurses meet are either under anaesthesia, unconscious or too sick to talk. Many nurses find it more rewarding to work within the community, perhaps in a health centre or attached to a family doctor’s practice. Here they have the satisfaction of providing continuity of care for people over a long period of time. In a family doctor’s practice a nurse may take charge of many routine procedures, such as dressings, injections and immuniz- ations, and sometimes she is able to hold her own clinics at the surgery. She may advise on family planning, or work in special family planning clinics. Community and district nurses form a valuable link between a patient and the hospital. By visiting people in their own home, and by providing more skilled nursing care than their families can give, the district nurse may enable a patient to have an early discharge from hospital, or enable someone with a chronic illness to remain at home. It may also be possible for the terminally ill to stay with their families if they receive regular visits from a trained nurse.
The nurse and the law
Because of recent technical developments in medical science, doctors delegate more tasks to nurses than ever before. This has created special difficulties concerning the precise responsibilities of the nurse. What is the legal position of the intensive care unit nurse who did not act and start resuscitation when a patient suffered a cardiac arrest? Professional neglect? What of the nurse in an intensive care unit who, without waiting to consult a doctor, did start reanimation in the same circumstances? Guilty of practising the medical profession even though unqualified? Of late, steps are being taken to protect the nurse from this kind of legal liability. It is clear that the nurse is no longer a simple doctor’s assistant. The nursing profession is an integral part of the health care system, with its own responsibilities and activities. «S1¥