Nursing at University College Hospital, London, 1862 - 1948

Nursing at University College Hospital, London, 1862 - 1948. From Christian Vocation to Secular Profession. Janet Likeman A Thesis submitted for the degree of Doctor of Philosophy at the Institute of Education University of London 2002 1 Abstract This thesis examines the development of nursing at University College Hospital, London, between 1862, the year in which the All Saints Sisters assumed responsibility for the provision of nursing services at the hospital, and the introduction of the National Health Service in July 1948. Although the care provided by the sisters marked a considerable improvement on what had gone before, in 1899 they were replaced by nurses whose motivation was professional rather than vocational. The profession of nursing was confirmed by the Registration Act of 1919. Following an introduction, the initial chapters of the thesis are concerned with defining and developing the themes of Christian vocation and secular profession. Chapter four is devoted to nursing management across the period, and the following chapter to patterns of care. Prior to 1919 a system of primary care was in operation; this was superseded by task allocation. Chapters six and seven outline the introduction of nurse training in some of the London teaching hospitals in comparison to the training of nurses at U.C.H. An analysis of the probationer records from 1890 - 1948 demonstrates recruitment and retention through these years. With the departure of the All Saints Sisters from U.C.H. in 1899 the school of nursing was established. A preliminary training school was introduced in 1926; ten years later University College Hospital school of nursing pioneered the block system of training which became the norm for all schools of nursing after the Second World War. The next two chapters concentrate upon nursing developments in wartime. The All Saints Sisters were part of the British Red Cross team that served in the Franco-Prussian War of 1870 and the hospital and its nurses were fully involved in the two World Wars. Although this period saw the transformation of nursing at U.C.H. from a Christian vocation to a secular profession, this thesis is as much concerned with continuity as with change - for example in noting the similarities between rules for the probationers and for the novitiates, which had continuing influence throughout the years of this study. 2 Contents: Chapter 1 Introduction Page 7 Chapter 2 Christian Vocation and Secular Profession Page 34 Chapter 3 Professional Organization Page 64 Chapter 4 Nursing Management Page 91 Chapter 5 Care and Control Page 122 Chapter 6 Schools of Nursing 1862 - 1919 Page 148 Chapter 7 U.C.H. School of Nursing 1920 - 1948 Page 189 Chapter 8 Demands in Wartime Page 231 Chapter 9 Vocation and Profession in Wartime Page 256 Chapter 10 Conclusion Page 282 Appendix 1 Patients treated at U.C.H. 1860-1899 Page 297 Appendix 2 Comparison of nursing curriculum pre 1919 Page 301 Appendix 3 Rules and Regulations at U.C.H. Page 303 Appendix 4 Questionnaire to U.C.H. sets 38, 55, 100 Page 312 Bibliography Page 315 3 Figures: Figure 1 The Social Background of Probationers 1889-1899 Page 39 Figure 2 The Religious Affiliations of the Probationers 1890-1899 Page 47 Figure 3 Work Schedules 1936/37 a) Night Staff Nurse Page 132/3 b) Night Probationer Page 132/3 Figure 4 Tasks during Training Set 55 Page 140 Figure 5 Tasks during Training Set 100 Page 141 Figure 6 Probationers Who Entered Training at U.C.H. 1890-June 1899 [a] Page 156 Figure 7 Probationers Who Entered Training at U.C.H. 1890 - June 1899 [b] Page 157 Figure 8 Age At Entry 1889-June 1899 Page 158 Figure 9 Home Address 1888 - 1899 Page 159 Figure 10 Probationers Who Entered Training at U.C.H. August 1899 - 1919 Page 167 Figure 11 Probationers at U.C.H. August 1899 - 1909 Page 168 Figure 12 Numbers of Probationers Who Left Training August 1899 - 1919 Page 169 Figure 13 Reasons for Discontinuing Training August 1899 - 1919 Page 170 Figure 14 Probationers at U.C.H. 1910 - 1919 Page 172 Figure 15 Reasons for Discontinuing Training 1910 - 1919 Page 174 Figure 16 Left to be Married 1899-1919 Page 177 Figure 17 Paying Probationers 1899-1919 Page 178 Figure 18 Probationers Who Gained the Midwifery Qualification 1899 - 1919 Page 180 Figure 19 Probationers Who Gained A Post Certification Qualification in Massage or Electric Therapy Treatment 1899-1919 Page 181 Figure 20 Probationers Who Entered Training at U.C.H. 1920 - May 1948 Page 191 4 Figure 21 Probationers at U.C.H. 1920 - 1929 Page 193 Figure 22 Failure to Complete the Course 1920 - May 1948 Page 195 Figure 23 Reasons for Discontinuing Training 1920 - 1929 Page 196 Figure 24 Probationers at U.C.H. 1930 - 1939 Page 198 Figure 25 Reasons for Discontinuing Training 1930 - 1939 Page 203 Figure 26 Probationers at U.C.H. 1940 - May 1948 Page 205 Figure 27 Analysis of Sets with Affiliates During the Second World War Page 207 Figure 28 Reasons for Discontinuing Training 1940 - 1948 Page 209 Figure 29 Hospital Certificate and State Registration Page 211 Figure 30 Additional Qualifications 1920 - May 1948 Page 213 Figure 31 Left to be Married 1920-1948 Page 216 Figure 32 Age At Entry 1923-1948 Page 218 Figure 33 Previous Experience 1923-1948 [a] Page 220 Figure 34 Previous Experience 1923-1948 [b] Page 221 Figure 35 Home Address 1923-1948 Page 223 Figure 36 U.C.H. Nurses Serving in the Armed Forces in World War One Page 239 Figure 37 The Number of U.C.H. Nurses who received the Royal Red Cross Page 240 Figure 38 U.C.H. Nurses Serving in the Armed Forces in World War Two Page 241 5 Acknowledgement I wish to convey my most sincere gratitude to Professor Richard Aldrich for his inestimable wisdom and endless patience. 6 Chapter One Introduction 7 Introduction The aim of this study is to trace the development of nursing and nurse training at University College Hospital, (U.C.H.) London, from 1862, when the All Saints Sisters became responsible for the nursing services at U.C.H., until 1948, when the voluntary hospitals, including U.C.H., became part of the National Health Service. It is an examination of the quality of nursing care which evolved through these years, and how nurses learned to care in a clinical world which was very different in some respects to the clinical world of today. In 1862 there were no models of nursing care, theories of nursing, or textbooks to explain the rationale for the nursing care offered. Nursing and caring for sick people at U.C.H. in 1862 was based on the Christian ethic of loving one's neighbour as oneself. As the years of the nineteenth century went by, nursing accumulated a body of knowledge, a nursing body of knowledge which expanded rapidly through the twentieth century. In this gathering of knowledge, the Christian ethic of loving one's neighbour as oneselfbecame the secular ethic of giving professional nursing care to the patients. Nursing is a complex activity. There is continuous debate on whether nursing is an art or a science, a discipline in its own right, or subservient to medicine. Nursing is about being with people at times which are never forgotten, the rites of passage from the moment of birth to the moment of death. Nursing encompasses the range of emotions - from elation and joy to great sadness. Nursing is not only concerned with physical well being, it is concerned with wholeness. Nurses during their daily work therefore witness many forms of human suffering, indignity and pain. People who are suffering require special consideration and care at whatever level their suffering occurs. The suffering encountered by fellow human beings touches the souls of the carers. "What is finally illuminated through historical investigation of a portion of the human past is the human situation."' Nursing is about the human situation. Examining the human situation as manifested at U.C.H. during the 86 years from 1862 to 1948 may bring a measure of clarity to the present. 8 Method The method used in charting the transformation in nursing 1862 - 1948 at U.C.H. was based upon consultation of a broad range of sources - both primary and secondary. The data were then examined by using the fundamental questions of why, what, how, who and when. Why? In the nineteenth century nursing was transformed through Christian vocation, the response from within the church which called for service to each other and especially to the poor and needy, one of Christ's commands to his followers. Appreciation of this distinctive aspect in the vocation of nursing is mostly summarised in a few words, whereas this study will examine its existence and trace the decline in the part played by this Christian concept of service within nursing, a reflection of the decline in Christian vocation in society at large. What? Christian vocation ensured that nursing was transformed by the act of caring. The concept of caring became part of the professional ideal. Nursing care required organisation which reflected the growing importance of professional issues. Who? The untrained nurse before 1860 cared for the sick in the context of her time - not all nurses were drunk and uncaring before the reforms of the latter half of the nineteenth century. Nursing was performed mainly by women; therefore any study of nursing has to consider the right of women to gain equality and complementarity and the role of nursing in this context. "The historian's ..

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