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Morais, Ernesto Jorge


Associated Professor of Nursing; RN; Specialist in Community Nursing; Master in Health Economics and management.

Nursing School of Porto, Portugal.

+351 914 502 058


Aim of the Study:

This study is part of an ongoing Nursing PhD investigation and aims to describe the academic and professional evolution of Nursing in Portugal, in the last two decades.

Rationale and Significance:

This investigation appears from the necessity felt in trying to understand a phase of enormous development of the Portuguese Nursing discipline.

Throughout the decades, contributes of individualities and groups have been fundamental in the most varied scopes and responsible for what it is today Nursing in Portugal.

In the recent times, other actors and scenarios disclose themselves as having a decisive and transversal role in the delineated trails at the different levels of this science.


A qualitative approach where, through documental analysis, interviews to key-informers and case studies of Nursing organizations of reference, was built a social-historic referential with the identification of a set of actors and scenarios considered fundamentals in the actual Portuguese Nursing context.


It was only in 1988 that the Nursing Course was integrated in the Portuguese Educational System, at the polytechnic level, what permitted the accomplishment of the degree of Bachelor to the undergraduate nursing students.

This integration also allowed the continuity of the postgraduate education, mainly in what respects to the attainment of academic degrees of Master and Doctoral in and out the specific area of Nursing, gotten from the frequency of courses provided by Portuguese Universities.

In 1996 was published the Regulation of the Professional Exercise of Nurses, fundamental to clarify and to consolidate the functions of Nurses in Portugal.

In 1998, with the necessity of proceeding to the creation of conducive mechanisms to the regulation and control of the professional exercise, the National Board (Order) of Nurses was created. From this date on, the exercise of the profession of Nursing is conditional to the attainment of a professional license, emitted from this Board.

In 1999 was initiated the License degree level to the undergraduate course of Nursing, passing from three to four years long, in polytechnic and university institutions.


By the research carried out emerged a set of actors and scenarios that disclose a detached role in the current Portuguese Nursing, namely the National Board (Order) of Nurses, the Unions of Nurses as well as some individualities with unquestionable importance to the present evolution of the Portuguese Nursing Science and Profession up to international levels and recognition.

Session 4e: Global Perspectives on Nursing Education



Paulo Fernando de Souza Campos

, Doctor in History. Ph.D. of Nursing History to the São Paulo University Program, School of Nursing



Aim of study

: This paper is part of a study conducted in the Post-Doctorate program at the University of Sao Paulo, which analyzed the development of nursing in Brazil after 1930. For this communication, we focus on the role of Ella Hansenjaeger, Navy nurse, adviser to the Rockefeller Foundation chosen to monitor the work of training at the School of Nursing, Faculty of Medicine, University of São Paulo from 1944 to 1951.

Rationale and significance:

The U.S. cooperation in training and development of modern nursing in Brazil is historically recognized. However, events of this process still remain poorly studied and may be revisited from biographical studies. When allowed to restore the role of subjects in the construction of social ties, the biography reveals aspects relevant to nursing research.


: The recovery of the individual in history can be evaluated as a reaction to structuralism approaches. The micro-historical research and biographical studies, resides in the interpretation of events less visible, tested individually and considers involving unexplored evidence by the traditional historiography. The primary sources were institutional records (minutes, reports, and letters) that document the performance of the American nurse consultant. The secondary sources consist of papers and memorials written by the Brazilian nurses, specifically.


: The proposals made by Ella Hasenjaeger reflected positively in different areas of the Brazilian nursing education, praised and recommended for services of health care as the Section of Nursing, from the Department of Sanitary Organization of the Ministry of Education and Health, who in 1946 published the making of the American nurse to the traditional Brazilian’s schools. The role of Ella Hasenjaeger favored the creation of internship programs in Psychiatric Nursing that didn’t happened, back then, in nursing schools in Brazil, as well as interest in scientific research, showing new perspectives to nursing working, and finally, a new professional identity.


: It was possible to conclude that both actions and the permanence of the consultant at the Nursing School of Sao Paulo was part of the project to impose their American health care model, as well as reorganization of services of health care in Latin America through whit the new model of Brazilian Nursing training. In this sense, it is concluded that the history of nursing allows reviewing the past of the profession and professional identity in the American way of life.


Dr. sc. hum. Christine R. Auer

Emmertsgrundpassage 33
69126 Heidelberg
Federal Republic of Germany

+49 6221 167335


Objective of the study:

The study will assist in the implementation of the Bologna Process. The problems in the implementation of study courses in West Germany between 1945 and German reunification are pointed out. Along the biography of nurse Antje Grauhan MA the first three attempts of academisation of nursing in Germany after 1945 (Heidelberg, Ulm, FU Berlin) as well as their failures are described. The fourth successful attempt in Osnabrueck with Prof. Ruth Schroeck (now living in Edinburgh), a companion of Antje Grauhan, is the conclusion of the study.

Importance of the study

In the Federal Republic of Germany currently Bachelor and Master courses are being established (implementation of the Bologna Directive). Through this study the historical foundations of nursing courses are to be documented and included in the curricula.

Methodology of the study

Narrative interviews of nurse Antje Grauhan who experienced all these attempts of academisation.
Analysis of the curricula of Heidelberg, Ulm, Free University of Berlin and Osnabrueck.
Sources of medical history regarding physicians relevant for these nursing courses (for example Prof. Dr. Eduard Seidler, Prof. Dr. Thure von Uexkuell, Dr. Karl Koehle).

Findings and conclusions

After the war had ended in 1945 the US Army established headquarters at Heidelberg. Heidelberg doctor Alexander Mitscherlich documented the Doctors’ Trials at the Nuremberg Military Tribunals (NMT) and in 1965 he got emigrated Jewish physicians to participate in the psychoanalytic congress at Frankfurt am Main. The U.S. occupation forces in Heidelberg wanted an academisation of nursing analogous to the development of the United States after World War I.

Before the year 1989/90 (German reunification) this desire could not realised.

Three failed attempts of academisation at Heidelberg, Ulm, and the FU Berlin were a paralyzing shock for nursing in the former Federal Republic of Germany. In order to study nursing so many German nurses chose the road to Edinburgh.

For the discussed period research of the history of nursing lags severely behind the history of medicine (Mitscherlich), making it difficult to this date to connect the West German nursing science to international developments. Equally difficult seems the connection to the nursing science of the countries of the former Eastern Bloc (DDR). In the case of the implementation of the Bologna Directive exactly that connection is of utmost importance. The study is supposed to help to facilitate the implementation of the Bologna Directive in nursing history and nursing science.



Hui-ping (Selina) LIN

386 Ta-Chung 1st Rd., Kaohsiung, Taiwan 81362, R.O.C

CICU, Kaohsiung Veterans General Hospital


Taiwan, R.O.C




Aim of study: The purposes of this study were: (1) to review the development and connotation of Puli Christian Hospital's Nursing School and (2) to examine the transmission and practice of the mission of the school.

Rationale and significance:

The modern Nursing education in Taiwan was founded by western Christian missionaries at hospitals in late 19th century. Today, Christian hospitals still play very significant roles in taking care aboriginal people sparsely domiciled in remote districts. However, the literatures related to history of both training programs and nursing schools established by Christian hospitals are very few. This study serves as a pilot research on the development of Puli Christian Hospital's Nursing School (1958-1970) from a historical perspective.


Literature reviews, document analysis and oral history research methods were adopted by this research. Data were collected from commemorative albums, archives, photos and in-depth interviews. A semi-structured interview guide was designed by the researchers for each interview. This study recruited seven interview participants, including graduates and teachers from the school and hospital administrators. Content analysis was used for the data analysis.

Findings and conclusions:

The development and connotation of Puli Christian Hospital's Nursing School were categorized as: core values and missions, theory and practice, values of religion and farewell to the Puli Christian Hospital’s Nursing School. The transmission of the mission of the nursing school could be illustrated as “cultivation of caring”; “practice of caring”, and “role model of caring”.

Session 4f: Courage in Adversity



Sonya Grypma

, RN, PhD | Associate Professor | School of Nursing | Trinity Western University| Langley, BC CANADA

1-604-513-2121 (3283)

sonya.grypma@twu.ca Funded by the Social Sciences and Humanities Research Council of Canada

Aim of Study

To explore and analyze Canadian missionary nurse Betty Gale’s response to increasingly devastating conditions as a civilian prisoner at Pudong [Pootung] Camp in Shanghai during the last two years of the Japanese Occupation of China (1943-45).

Rationale and Significance

As one of six China-born children of Canadian missionaries (“mishkids”) who chose to return to China as nurses during the Japanese Occupation, Betty Gale’s China life represents a largely unknown phenomena in Canadian mission history – the internment of Canadian nurses. Part of a larger biographical study of the China life of Betty Gale (1911 – 1945), this paper focuses on her last two years in China as a civilian prisoner with 1200 other enemy aliens in the notorious Pudong Camp. This study adds to the body of scholarship on the imprisonment of American and Australian military nurses under the Japanese in the Philippines and Indonesia by adding a civilian perspective of China-born Canadian nurse-prisoners in Japanese war camps.

Methodology and Sources

Building on the author’s established research program on Canadian missionary nurses in China, this study utilizes a biographical method as a lens through which to better understand not only the life of one person, but the broader social phenomena of mishkid nurse internment. Sources included Betty Gale’s unpublished diary kept during internment, photographs, film footage and hundreds of pages of private letters, memorabilia, newspaper clippings and internment camp newsletters. Also included were taped interviews of Betty Gale and five other internees. The United Church of Canada Archives and National Archives of Canada provided official mission communiqués and International Red Cross reports on conditions in China’s internment camps respectively. Finally, fieldwork was conducted in China as the researcher joined Betty Gale’s family members on visits to sites where Betty lived and was interned.


Betty Gale’s decision to remain in China against consular advice in 1941 marked a new epoch in the history of Canadian missions in China. For the next four years the missionary gaze was turned from the Chinese populace outside mission walls to fellow prisoners within them. Betty’s arrest and subsequent four-year imprisonment in a series of camps culminated in two final years of neglect, starvation and terror during the eventual months of unrelenting air raids over Shanghai. Betty Gale’s personal quest for survival and purpose mirrored the collective missionary pursuit of equilibrium in the increasingly unstable and unrecognizable world of China missions – a pursuit that was effectively abandoned after the release of surviving internees in 1945.


Dr Barbara Mortimer


Dr Mortimer is currently working as a Research Assistant with the Oral History Archive of the Royal College of Nursing on a history of nursing in Britain during World War 2.

 0131 447 2592 Barbara.Mortimer@rcn.org.uk
Aim of study: To explore the professional position of the British nurses who remained to nurse in the Island of Jersey in the only part of Britain occupied by the enemy in World War 2. Rationale and significance: The Channel Islands of Jersey and Guernsey in the Gulf of St Malo are geographically closer to France than Britain and following the Allied retreat from mainland Europe in 1940 British troops were withdrawn from the Islands leaving the territory effectively an ‘Open Town’.

Following a rapid and rather undignified rush to evacuate the now unprotected and undefended Islands, German forces moved in on 30th June 1940. They remained for five years. Nurses were isolated from their Statutory Body, the General Nursing Council for England and Wales (GNC) and their Professional Body, the Royal College of Nursing (RCN).

To date there has been no formal study of the professional or individual position of nurses in the trying conditions of the Occupation. Methodology: This paper uses a very rich tradition of published ‘local’ history together with oral history accounts of nurses who experienced the Occupation and the records of the Statutory Body, the GNC. It asks if professional standards alter in such circumstances, examines the dilemmas posed for practitioners and explores how they perceived and met their responsibilities towards the profession, each other, colleagues in other professions, patients and their families. Findings and conclusions: It appears that a professional respect and detachment towards the occupying forces was cultivated which enabled British nurses to continue caring effectively for their patients and to meet the educational requirements of the GNC.

Following Liberation on 9th May 1945 student nurses who had undertaken training in the Island were able to enter for the next GNC examinations and at least ten ‘Jerseygirls’ passed their examination and registered ‘SRN’ on November 23, 1945.


Dian Baker

, PhD, APRN-BC, PNP, Postdoctoral fellow in nursing

Betty Irene Moore School of Nursing University of California, Davis

1-530-400-2866 or 1-530-753-6822 (USA)


Aims of the Study:

(1) Explore the lived experiences of Hmong women and men who developed and practiced the profession of nursing from 1950 to 2000 in Southeast Asia; (2) Develop insight into how the nursing profession is established in region where it was previously unknown; (3) Relate the richness and depth of the experience of the Hmong nurses, who stepped far outside their expected role to provide healthcare; and (4) Relate their experiences to the role nurses have today.

Rationale and Significance:

From 1950 to 2000 the country of Laos underwent many significant changes. In 1960-70’s during the Vietnam War, the United States engaged in a secret war staged from the highland plains in Laos. The U.S. built airfields in Laos with assistance from the Hmong, an agrarian, patriarchal group that practiced animist beliefs and primarily used shaman and herbalist as provider of healthcare. After the fall of Saigon in 1975, Southeast Asia was in political upheaval and eventually many of the Hmong were relocated to refugee camps. During these periods of upheaval little is known about how healthcare or nursing care was provided for the Hmong. During this time a group of Hmong women and men established a nursing care educational system. Results from the study add to the knowledge of nursing history through understanding the development of nursing practice under conditions of significant societal stress and where Western medical practices align with historically animist health belief systems.


Individuals interviews with eight Hmong nurses, field interviews with leaders of the Hmong community, and examination of historical artifacts such as photos were used to gather data. Interviews took place in English. An interpretive phenomenological approach was used for analysis. May Ying Ly served as the cultural broker for this study; she was the cultural broker for Anne Fadiman’s National Book Circle prize winning book, “The Spirit Catches You, You Fall Down”.


A group of Hmong women and men established and practiced nursing during the Western occupation in Laos and afterward in the refugee camps. The story is one of strength, determination, resilience, and passion to provide excellent nursing care for their community. They overcame multiple obstacles including a dominating patriarchal system that discouraged women from entering nursing.


The story Hmong nursing history helps to explain how nursing establishes itself as a profession and how the nursing profession survives during times of significant societal change.

Concurrent Session 5

Session 5a: Panel Presentation: Nurses on the Front Line:

Representation and Autonomy


Author: Christine E Hallett PhD

Manchester University

Aim of the study:

The aim of the project is to explore literary representations of nurses, written by nurses who practised during the First World War.

Research questions addressed:

How did those who nursed the wounded of the First World War view their work, their role and the significance of their involvement in the war?

In what ways have a small minority of ‘literary’ nurses portrayed these themes through their published writings?

Why and how did nurses use traditionalist and modernist styles of literary writing to convey their experiences of war?

How may an analysis of these works create interpretive links or ‘bridges’ between literature and the theory and practice of nursing?


There have been other texts developing literary critiques of the writings of First World War nurses. The work of Agnes Cardinal et al (Women’s Writing on the First World War), Dorothy Goldman (Women and World War I: The Written Response) Margaret Higonnet (Lines of Fire. Women Writers of World War I; Nurses at the Front: Writing the Wounds of the Great War), Sharon Ouditt, (Women Writers of the First World War) and Angela Smith (Women’s Writing of the First World War: An Anthology), have offered important insights into women’s wartime roles. This project is very different in its emphasis from earlier compilations: it examines only the writings of nurses (rather than on ‘women’s writings’ more generally) and it emphasizes those elements of the texts that focus on the nature and meaning of nursing and the role and position of the nurse during wartime.


Excerpts from the works of nine nurse-writers are to be presented, categorized as enthusiastic clinicians (‘healers’), romantic adventurers (‘heroines’) and detached critics (‘harpies’). Detailed archive searches have been undertaken in order to obtain material relating to the lives of the authors to be studied. An element of literary criticism is used in the analysis of the main texts. The main emphasis will be on the ways in which each author projects the image of the nurse and of herself within a nursing context.

Findings and Conclusions:

The project explores the ways in which the nurse-writers of the First World War positioned themselves as ‘healers’, ‘heroines’ or ‘harpies’. ‘Healers’ are presented as individuals who adopted a traditionalist form of adventure-writing to convey a sense of the significance of nursing work and what they saw is the admirable qualities of the nursing character. ‘Heroines’ were also writing within a traditionalist style. Their intention was, primarily, to convey a sense of the adventurousness of the ‘nursing spirit’: to present themselves as exemplars of women who traveled far from home, often to remote areas of the world, confronted danger and the challenges presented by nursing work, in particular the need to compose oneself as a strong and compassionate carer in the face of intense suffering. The term ‘Harpy’ for the third category of writer requires some justification. Apart from the obvious lure of a neat alliterative title, this term conveys the quite deliberate insistence of my last three writers to stand outside – both stylistically and ideologically – the traditionalist framework of their time.

Conflict, change and continuity:

war and nursing in the East of Empire

Rosemary Wall

, Ph.D., Research Fellow

Anne Marie Rafferty

, Ph.D., Dean, Florence Nightingale School of Nursing and Midwifery, King's College London, England.

020 7848 3962

rosemary.wall@kcl.ac.uk (main contact); anne_marie.rafferty@kcl.ac.uk

Aim of study

There were 176 British colonial nurses in the Malay Peninsula when the Japanese invaded in 1941-2. 44 died and many were imprisoned in internment camps where four more died. Whilst the British were interned, the locals kept the health services running. This paper explores the influence of the Second World War and the Malayan Emergency on the development of nursing in Singapore and British Malaya. The subsequent decisions regarding the levels of involvement of the Overseas Nursing Association in the continuance of nursing services and training are examined.

Rationale and significance

This paper focuses on the area of the British Empire which hosted the largest number of colonial nurses in the world. The history of healthcare in South-East Asia is underexplored in comparison to historical research on Africa. A tumultuous time is explored, when Britain was trying to hold on to an area of Empire under the threat of Japan and subsequently communism. Nurses were used as emblematic of the benevolent aims of colonial rule, and we examine how they were represented and self-represented in a variety of media.


A range of primary sources are utilised: film from the Imperial War Museum archive, oral histories conducted by the authors and from the collection at the National Archive of Singapore, memoirs, letters, the press, and British, Malaysian and Singaporean reports. Secondary literature on South-East Asian nursing is underdeveloped, but the paper will draw on work by Lenore Manderson on the history of medicine in the area, and on colleagues’ work in progress on white women, missionaries, Eurasians and Malayan responses to Western healthcare in the Malayan peninsular.

Findings and conclusions

In 1945, the locals returned to their old positions whilst the British took charge of healthcare again. Additionally, British military nurses who came to work in the Malay Peninsula requested to stay and become part of the ONA, leading to difficult decision making for the organisation which wanted to maintain elitist standards but also to fill vacant posts. From 1956-7 British nurses for general duties were no longer required in Singapore and Malaysia. However, there were requests for British nurse tutors to remain, but subordinate to Asian nurses. Many senior British nurses left under the Malayanisation programme causing shortages of tutors, and the World Health Organisation was relied upon for help. This paper examines the conflicts, representations of, and power struggle between British and Asian nurses.



Elisabetta Babini

, Doctoral Candidate.

Florence Nightingale School of Nursing and Midwifery/School of Arts & Humanities, Centre for the Humanities and Health, King's College London, England.

0752 7871154.


Aim of study

Nineteenth and early twentieth century British history counts among its protagonists two extraordinary women who passionately devoted their lives to others and made the nurse's assignment a real mission: Florence Nightingale and Edith Cavell. Respectively the 'modern nursing mother' and the 'self-sacrifice symbol', such exemplary nurses also shared experiences of active commitment to the profession in war time. The present paper aims at analysing how the camera has represented their profiles over the last century, with particular regard to biopics and to the war theme.

Rationale and significance

The investigation shall be developed according to an interdisciplinary approach. Therefore, starting from references to history of nursing and to film studies theories, the paper examines such cinematic portrayals by involving also gender, cultural and feminist studies. The final purpose is, first, to verify which kind of 'nurse's image' cinema has suggested and, second, to estimate whether this representation had any social impact. In the substantial critical body, little has been written about this comparative theme so far. Thus, it would be interesting to study the subject in depth and widening the present knowledge on it.


Through the screening of biopics on Nightingale and Cavell, and given both history and the history of nursing testimonies on them, the paper shall investigate whether it is possible to parallel gender, cultural and women’s studies theories and the cinematic representation of such figures. Primary sources are Herbert Wilcox's productions Nurse Edith Cavell (USA, 1939) and The Lady with a Lamp (UK, 1951), and material such as actress Anna Neagle’s autobiography. Secondary sources include the few publications currently available about the topic by Julia Hallam, Beatrice and Philiph Kalisch and David Stanley as well as several key-contributions on the social history of nursing. Additionally, works within the Film Studies field will be utilised, in particular the ones written by feminist theorists such as Alison Butler, Molly Haskell, Laura Mulvey and Yvonne Tasker.

Findings and conclusions


Nightingale and Cavell's biopics distinguish themselves from the rest of cinematic productions on nursing released by the early 1950s since they communicate a new image of the category: no longer focused on stereotypical ideas of female weaknesses but rather emphasising nurses' professionalism. This had a more substantial impact on society than deliberate recruitment films.

Session 5b: Maternal and Child Health



Prof. Elaine Hobby,

BA (1978), PhD (1984) Birmingham University; MA (1979) Essex University

English and Drama Department,

Loughborough University;

01509 222950;


Aim of study

This paper will introduce the first English midwifery manual, The Birth of Mankind, which was in print from its first appearance in the reign of Henry VIII in 1540, until its usurpation by the new information about midwifery practice that was made available by Nicholas Culpeper (of Culpeper’s Herbal fame) during the 1650s. It will analyse the ways in which the book related to the professional identity of English-speaking midwives, and how this connected to ideologies about the nature and abilities of women more generally.

Rationale and significance

The Birth of Mankind is a fascinating text, including sections on female reproductive anatomy, on normal and obstructed labour, and on postnatal care of both mother and infant. The paper shows how familiarity with it increases our understanding of the history of midwifery, and of the struggles that early midwives faced to be seen as skilled professionals.


The key sources for this research are the many editions of The Birth of Mankind that appeared between 1540-1654. The paper will work by analysing in close detail what the book says about midwifery practice, and how this changes between 1540 and 1654. Because the earliest version of the book was based on a German midwifery manual of 1513 that was intended for use in the training of midwives, comparisons between the German original and the English version will also be made. Also crucial to an understanding of The Birth of Mankind is its relation to the Vesalian anatomy of the 1540s, and the paper will show how The Birth of Mankind borrowed from and changed Vesalius’s ideas, producing a far more woman-centred understanding of the reproductive process than characterises De Fabrica.

Findings and conclusions

The paper will show how the physician-controlled model of midwifery that characterised the German source of The Birth of Mankind was shifted for its English-speaking audience, which consisted both of midwives, and of general readers interested in reproduction. It will be argued that the emergence of Protestantism in Britain in the mid-1500s also played a crucial role in changing understandings of conception and birth from the German and Italian Catholic assumptions of the book’s originals. Finally, the paper will suggest that The Birth of Mankind is a precious source for our history, and that it should be more widely used by historians of midwifery.


Clare F Ashton


Public Health

64 3 755 7744 clare.ashton@ihug.co.nz
Aim of study

‘War is good for babies’ was Dr Josephine Baker’s line summing up fund raising for baby care in early twentieth century New York. Deborah Dwork quotes this in her work on the history of infant welfare in that period in England. This presentation asks the question: was World War One also ‘good for babies’ in NSW Australia?

Rationale and significance

Mothercraft services in 1920s NSW seemed a turmoil of disparate interests and historians have focussed on feeding regimes and patronising male dominance as the rationale. This study widened the scope for assessing the turmoil by examining the sectoral interests in baby health at the time in NSW Australia. It also detailed the sequence of events to clarify the genesis of apparently competing mothercraft services.


The records of the NSW Department of Public Health and mothercraft organizations were the main sources used to unravel the origins of the mothercraft services in Sydney. Commentary from Australian historians of governmental welfare policies provides supporting evidence.

Findings and conclusions

Mother and baby services in NSW were shaped by the political upheavals that followed the contentious Australian referendum on military conscription in 1916. One of the political outcomes of the conscription divide was a conservative shift in attitudes towards welfare and this was the basis for the 1920s controversy over baby care in NSW. The personal professional interests of the nurses and doctors involved in mother and baby services were not immune from the effects of the War either. They exhibited the effects of the War on the returning servicemen and women, and the attitudes of those who had kept the health services operating at home. World War One did affect the baby care services in NSW Australia but not as conclusively as it did in other English speaking countries.



Nena Patterson

, RN, MSN/PhD Student

University of Virginia

School of Nursing



Aim of Study:

The purpose of this study was to determine what themes characterize WWII EMIC program letters and identify the level of comprehension and specific attitudes of those directly involved with the Emergency Maternity and Infant Care program of World War II.

Rational and Significance:

The Emergency Maternity and Infant Care Program (EMIC) enacted during WWII provided maternal/infant care to enlisted servicemen’s wives in the 4th, 5th, 6th, and 7th pay grades of all military branches and was in operation from 1943-1947. EMIC was created from a response to an identified medical care disparity. There remains a significant gap in the literature about how those directly involved with EMIC comprehended the programs and its services as well as what their attitudes were regarding the program. This analysis seeks to fill an identified gap and explore the understanding and attitudes of soldier’s, their wives, and military as well as civilian officials through an analysis of a group of their letters written during program operation 1943-1947.



Social history methods were employed in this study. The primary source was a sample of EMIC letters obtained from Children’s Bureau documents at the National Archives, College Park, Maryland. Secondary sources included medical, nursing, and military historical writings of World War II.

Findings and Conclusions:

Frustration, misinformation, and attitudes about EMIC eligibility and provisions for care were themes identified within the overall body of letters. The analysis substantiated that the program was established to provide maternity care benefits for active duty enlisted servicemen in the 4th lowest pay grades but physicians could opt out of this national maternal health program and this analysis notes that they often did so. Also, during program evolution, the Children’s Bureau had to revisit basic policy and specification of eligibility as well as redefine criteria for previously unconsidered groups such as veteran’s dependents or dependents of men killed or missing in action. Under EMIC the Children’s Bureau made standards of care mandatory for approval of state plans for both, hospitals as well as individual providers and this letter analysis corroborates this requirement. Along with the maternity care benefit of access to care, EMIC potentiated an increase in the quality of care provided for not only EMIC participants but to other pregnant women of the WWII era.

Session 5c: International Collaborations


Glicerio Moura


Lienhard School of Nursing, Pace University

Pleasantville, New York Gliceriomoura@hotmail.com

Sandra B. Lewenson


Lienhard School of Nursing, Pace University

Pleasantville, New York slewenson@pace.edu

Aim of the Study

: This study examines the stories of nursing students who participated in the 1972 Project Hope internship in Natal, Brazil.

Rationale and Significance

In 1972, Project Hope sent the hospital ship “Hope” to establish a year-long health cooperation mission in Natal, Brazil, located on the northeastern coast of Brazil. During that visit, a group of thirteen nursing students from a local public nursing school participated in an internship program on-board the hospital ship. By collecting their oral histories, an understanding of how this American initiative influenced the evolution of nursing and nursing education in Brazil during the late twentieth century is gained. In addition, this international historical research project provides insight into cross-cultural issues and collaborating partnerships that has relevance today.


Oral histories were collected from thirteen former student nurses and one administrator who participated in the 1972 Project Hope mission. Interviews lasted approximately 60 minutes, with open-ended questions about past participation in the Project Hope Internship Program. An Institutional Review Board application was submitted and received an expedited review. The interview tapes were transcribed and translated from Portuguese to English.

The oral histories served as the major primary source material for the study. Secondary sources included materials reflecting the development of nursing education in Brazil, the background of the 1972 Project Hope mission in Natal, journal articles on historical research methodology, feminism, and writings on nursing education in Brazil and the United States.


The internship program exposed the nursing students to American technology, education, and culture. The students respected the technology and the way they learned to care for patients. They also felt respected for what they could bring to the setting, even though they were second year students. The experience allowed the students to see various ways of knowing and doing. When the students returned home they adapted what they had learned into their own reality.


: The students described the experience as “priceless.” The history shows the richness of such a program facilitating a mutual respect between two cultures and the subsequent influence of their experiences on health and education in Brazil. International historical research provides evidence that can be used in developing future collaborative international cross-cultural initiatives.



Susanne Malchau Dietz,

Associate Professor, PhD

Institute of Public Health

Department of Nursing Science

University of Aarhus

Hoegh-Guldbergs Gade 6A

DK-8000 Aarhus C, Denmark

Phone: +45 33 26 26 07 sm@nursingscience.au.dk
Aim: To do a case study of the roots, expressions, and significance of transfer of nursing knowledge between the USA and Denmark 1945-1970.
Rationale and significance: In the 1950ies the Danish matron Sister Benedicte Ramsing (1912-1988) introduced the American “Unit Learning” model at the Saint Joseph School of Nursing in Copenhagen. The starting point was when Sister Benedicte 1948-1950 studied at the School of Nursing Education at the Catholic University of America, Washington DC. Here professor Loretta Heidgerken (1908-1996) introduced her to the “Unit Learning” model ”that all the varied phases of education should be integrated so that the student’s experiences and knowledge will be one harmonious whole” (Heidgerken 1946, p.171). Within a few years Sister Benedicte imported and refined the Unit Learning model into a Danish nursing culture and context. The question is to what extent was the model described, put into practice and accepted in the USA? In which form was it transferred to Denmark? In which way did region, culture and professional and religious affiliation influence the transfer of nursing knowledge?
Methodology: The study is an empirical historical comparative study based on primary sources from Saint Joseph School of Nursing in Denmark, the Catholic University of America and two schools of nursing in the region of Philadelphia (Chestnut Hill and the University of Pennsylvania schools of nursing) found in the collections at the Barbara Bates Center for the Study of the History of Nursing, University of Philadelphia. Secondary sources are published works about nurses’ education in Denmark and USA in the period in question. An important secondary source is a biography of Sister Benedicte where the education at Saint Joseph School of Nursing is analyzed and described thoroughly (Malchau 1998).
Findings and conclusions of the study emphasize the theme profession, identity and ideology. It will be argued that transfer of knowledge from the USA to Denmark was an important means in building up the nursing profession as an academic discipline in Denmark and that it furthermore promoted a sense of international shared nursing identity. When it concerns Saint Joseph School of Nursing in Copenhagen it will be demonstrated that differences in educational legislation and culture were an obstacle in implementing the American curriculum while religious affiliation only caused minor problems. The results are discussed within the concepts of imperialism versus global nursing community defined in terms of equality.


Tiago Braga do Espírito Santo

– reporter, Master in Nurse by the Post Graduation Program of Nurse of the Nurse School of the University of São Paulo (EEUSP), tbes81@gmail.com

Dr. Taka Oguisso,

Headmaster of the Nurse School of the University of São Paulo (EEUSP), takaoguisso@uol.com.br

Escola de Enfermagem da Universidade de São Paulo



Aim: the beginning of the Brazilian nursing professionalization through the coming of French nurses, from 1890 to 1895, to the Insane National Hospital (HNA), Rio de Janeiro, capital of the recently installed republican government. The contract which facilitated the coming of those professionals was one of the government strategies to solve the institutional crisis caused by the Sisters of Charity who had gone from the hospital, where they exerted nursing care. Objectives: to identify possible circumstances that had culminated in a contract, signed between the Brazil and France governments, which has promoted the French nurse arrival to the Insane National Hospital, Rio de Janeiro, 1891; to describe the laicization process within hospitals and the French nursing professionalization, defining the profile of nurses educated by the Salpêtrière School; to analyse the trajectory of these professionals coming to Brazil, within the historical context of the beginning of the First Republic; to survey possible activities French nurses had performed at the Insane National Hospital. The theoretical and methodological foundations were done based on the proposal Social History and Micro-history, with dense description technique for narration. Data collected were interpreted according to the written history of Burke, linked to the object through data triangulation. Documental corpus is made up mainly by ministry reports of that time and on some evidences about French nurses disposed by the Itamaraty Palace (Ministry of External Relations) documentary archives. Another important resource was the written media. Through this study it is possible to notice the turmoil context which gave origin to the French nursing and the existence of several models in France, among which had prevailed the of Br Bourneville who acting as a physician, politician and journalist established training schools and wrote nursing manuals which have influenced several countries worldwide. The Brazilian context was much disturbed during the transition from monarchy to the republic at the end of the XIX Century, motivating socio-political changes which have characterized the country as an importer of European positive-evolutionist ideas, concretizing the intention of civilizing the nation. This had as scenario the social medicine and psychiatry development as a way of hygienezation/exclusion. Relating nursing development in France with Brazilian republican ideas, it is noticed that bringing approximately 40 French nurses to work at HNA was directly linked to the intention of reaffirming the recently established government intention to create a career for women inspired on Bourneville nursing model.

Descriptors –history of nursing; nurses (1890-1895); Hospitals, Psychiatric (Rio de Janeiro)

Session 5d: Nurse Recruitment and Nursing Education



Carolyn Gibbon


University of Central Lancashire

01772893639 cjgibbon@uclan.ac.uk
Aim of study: To review a series of Registers of Probationer Nurses in order to examine issues of recruitment and retention.
Rationale and significance: The Metropolitan Poor Law Act 1867 enabled Poor Law Infirmaries to train nurses to provide care for the sick poor. Recruitment and retention has been a cause of discussion for many years and this study identified issues that have resonance with today, including previous experience, poor health prior to and during training, and the relatively low numbers who completed their training and remained at the hospital as staff.
Methodology: Documentary analysis of a series of six Poor Law registers of Probationer Nurses from Mill Road Infirmary, Liverpool. The analysis covers a period of forty years from 1983-1933 and formed the basis of the research, supported by research by White (1978) amongst others.
Findings: The recruitment pattern altered over the period under investigation, reflecting the societal changes that were taking place, and included a significant number who reported previous nursing experience. At this time the majority of probationers were local to the hospital, but it is especially noted that during the interwar years, a number came from rural areas.

Training commenced following a probationary period, or trial, though there were some exemptions. All probationers underwent a medical examination prior to training and a number were found to be unfit, including probationers who had transferred from other hospitals to complete their training. Ill health amongst the probationers is also noted intermittently with cases of infectious diseases being sent to the local isolation hospital. Arguably the rates of infection were dropping amongst the probationers, though there were periodic cases of enteric fever. Improved nutrition, healthier candidates, and an understanding of infection may have contributed to this.

Retention of staff largely depended on the financial position of the hospital. Over the period of study, 58% completed their training, but only 15% of this number took up staff posts. Probationers did not complete their training for a variety of reasons, including not being suitable, or to be married.
Conclusions: It is contended that during this period of study, probationers saw nursing training as an opportunity to work and to increase their status which in turn increased opportunities for promotion and increased salary. Reasons for leaving included not being suitable, ill health, or not finding nursing suited them.




Susan A. LaRocco


Professor, Curry College, Milton, Massachusetts USA



Aim of Study:

The Alexian Brothers Hospital School of Nursing in Chicago, founded in 1898, was the fifth all male nursing school in the United States. By the time it closed in 1969 a total of 779 lay and religious men became nurses as a result of their education at this school. A unique aspect of their education was that they were in a setting where all of the patients, as well as all of the nurses, were male. Their care of female patients occurred during affiliation at other hospitals including maternity and pediatric facilities. The aim of this study is to present the oral histories of these men, especially their decision to choose nursing as a career and their experiences during their pre-licensure nursing program.

Rationale and Significance:

The recollections of these male nurses will add to our understanding of what it was like for a man to choose nursing as a career at a time when less than 2% of all nurses in the United States were male as well as what it was like to attend a religious affiliated all male nursing school.


Oral history interviews, focusing on the men’s decisions to become nurses, choice of school, and the obstacles and opportunities that they encountered throughout their careers, and their contributions to health care as nurse anesthetists, administrators and educators, were conducted with 23 graduates of the school. All interviews were conducted in person and were audio-recorded, transcribed and participant checked for accuracy. MaxQDA, a qualitative software package, was used to assist with data management and analysis. Other primary sources included the records of the Alexian Brothers Hospital School of Nursing. Secondary sources included books and articles referencing men nurses and nursing education in the 1950s and 1960s and nurse anesthesia in the United States from the 1950s to the present.

Findings and Conclusions:

Men who graduated from the Alexian Brothers Hospital School of Nursing chose nursing for a variety of reasons. The low cost of their education was often a factor. For many, their desire to become Certified Registered Nurse Anesthetists (CRNAs) influenced their decision. All of the men indicated that they received an excellent education that was the foundation for their continued education and successful nursing careers. They also reflected on the values of compassion and service that were developed in them while they were learning from the Brothers.



Keith C. Mages


Doctoral Student

University of Pennsylvania, School of Nursing

(716) 361-4000


Aim of Study

This paper analyzes the creation of a unique library classification system developed specifically to organize the texts of an early 20th century nursing library.

Rationale and Significance

Bellevue School of Nursing Instructor Ann Doyle created the Bellevue Classification Scheme (BCS) during the early 1930’s. Doyle surveyed existing library classification systems and found them inadequate to the needs of nursing. The resulting Bellevue Classification System (BCS) became the model organizational scheme for nursing libraries, and was supported and disseminated through multiple editions of the National League of Nursing Education’s Library Handbook for School of Nursing. A careful analysis of both the process of creating and the ultimate structure of the BCS offer an early example of how the construction and organization of a library’s materials produced and disseminated a gendered group’s perceived domains of influence and authority.


Using the methodological tools of social history, this paper juxtaposes the BCS’s origin, structure, and content against those of the classification schemes consulted during the drafting of the BCS: the Dewy Decimal Classification (DDC), Library of Congress Classification (LCC), Boston Medical Library Classification (Ballard), and the National Health Library Classification (NHLC) schemes. This paper provides a textual analysis of data from these sources, in conjunction with associated published and manuscript data and relevant secondary sources on gender and library classification systems.

Findings and Conclusions

The Bellevue Classification System was intrinsically linked to turn-of-the-20th-century America’s burgeoning library culture. The most well known products of this culture, the DDC, LCC, Ballard, and the NHLC were carefully studied by Doyle who rejected them as neither a particularly encompassing nor reflective of nursing’s dynamic knowledge domain. These systems, though, did serve as both catalysts and reference points as Doyle constructed the BCS, a new scheme that promoted a distinct perspective on nursing knowledge. In its final form, the BCS also created a legitimate space for the organization of traditionally feminized knowledge. In total, the BCS allowed Doyle to portray nursing as a gendered, yet intellectual, professional discipline.

Session 5e: Nursing and Women’s Health



Pauline Brand

PhD MSc (Nursing) BA (Hons) RN RM RHV

The Open University, 12 Hills Road, Cambridge. CB2 1PF

p.brand@open.ac.uk Tel: (+44) 1223 364721

Purpose of Study

This paper forms part of a wider study of birth control nursing which has traced the contribution of the pioneering nurses and midwives who chose to work in what was considered to be a controversial clinical area.

Rationale and significance

In 1924 the Ministry of Health maintained its stance that women needing contraceptive advice on medical grounds should be referred to a private doctor or a hospital. Various associations had opened clinics throughout the country but the newly opened Abertillery Hospital, situated in an economically deprived area in South Wales, was the first to offer such a service with a clinic staffed by Nurse Naomi Jones.This paper explores four issues; the debates between the protagonists concerning the establishment of the clinic; the early career of Nurse Jones; the service provided in the clinic and finally the campaign which resulted in its closure.

Sources and Methodology

Primary and secondary sources were interrogated to produce a case study of the Abertillery clinic. Primary sources included material from the Marie Stopes’ collections in the Wellcome Contemporary Medical Archives and the British Library

Findings and Conclusions

In 1924 the Secretary of Abertillery Hospital contacted Marie Stopes seeking guidance on the logistics of establishing a birth control clinic. Stopes participated in the selection of a suitable candidate, Nurse Naomi Jones. The clinic opened in 1925 and initially appeared to be successful but during 1926, Nurse Jones letters to Stopes became increasingly despondent as she described the opposition she was facing from local Churches and members of the hospital committee. Within 16 months the project was at an end and a disappointed Jones wrote to say that the clinic had been killed by gossip. This case study provides one illustration of the difficult task faced by those nurses and midwives working in this controversial area during the early years of the birth control clinics.


BETWEEN THE 1930s AND 1960s.

Dr Susan Snoxall,


07810 540277 and 01747 835991

This paper will consider the treatment of women requesting termination of pregnancy prior to the Abortion Act of 1967 and the part played by a specialist women’s hospital.

Gynaecologists at Chelsea Hospital for Women carried out terminations in the knowledge that they were breaking the law, the Offences Against the Person Act 1861.

Chelsea Hospital for Women was a place where women could go if they could find a medical practitioner who was prepared to refer them. Not all medical practitioners or gynaecologists approved of termination of pregnancy, even on medical grounds, but some were be prepared to give the name of another colleague who would help or advise where they might seek help. Women from a higher social class potentially had greater access to private medical care where termination, in the form of a dilation and curettage, could be performed in a private nursing home. Women from a lower social class were more likely to have sought help elsewhere, possibly from a ‘back street’ abortionist or attempted to terminate the pregnancy themselves.

Information that will be presented includes consultant case books, clinical yearbooks and the views of gynaecologists and nurses working during this period. It will also consider the effect of the Rex v. Bourne case in 1939 where the judge Mr Macnaughten, held that it was not unlawful for Mr Aleck Bourne, a consultant gynaecologist, to terminate the pregnancy of a 15 year old girl. This became known as the Macnaughten ruling.

Figures will be presented on numbers of terminations, procedures used and the medical conditions recorded as to why the procedure was undertaken. Exactly how gynaecologists and gynaecological nurses assisting in these procedures dealt with their consciences is difficult to ascertain, but those interviewed did express views on the work and the care they tried to deliver to women. Both professional groups were undoubtedly influenced by women, who needed admission following attempts at ending the pregnancy themselves or those who may have sought the services of a ‘back street’ abortionist. Reflection on the history of abortion may offer insight and understanding to those treating women with unwanted pregnancies in the twenty first century.

Session 5f: Nursing Leadership



Stephanie Kirby


Visiting Research Fellow, Faculty of Health and Life Sciences

University of the West of England, Bristol, UK




The purpose of this paper is to recover the life and work of Marjorie Bell, MBE Matron of Lewisham Hospital, London 1948-1970. During her long career she became a respected figure in the nursing world, and a prominent member of the local community. But like many nurses who gained such recognition in their own life time, the memory of her contribution to professional and local life has faded with the passage of time.

Rationale and Significance:

Marjorie Bell’s story reflects the way in which a woman with vigor and determination could make her way in the world through a career in nursing. She provides an exemplar of a practitioner who applied theoretical and experiential knowledge to the development of nursing practice.

Methods /Sources:

The core source for this paper is a life story interview with Marjorie Bell from the last year of her life. Interrogation of other documentary sources helped to place her life and work within a wider sociopolitical context. Primary sources include records of the London County Council (LCC), the National Health Service (NHS), the General Nursing Council (GNC) and newspapers.


In 1928 Marjorie joined what was to become the LCC Nursing Service as a probationer fever nurse. Thanks to the LCC unified career structure she held positions at 15 of its hospitals, undertaking professional development courses and gaining promotion. During World War II she was a Night Superintendent dealing with the results of bombing on the civilian population of London. This proved of great use when the casualties of two horrendous train crashes were received at Lewisham Hospital. As a hospital matron in the NHS she was concerned over the weakening of the nursing voice within the hospital management structure and worked to form a relationship with the hospital administration that allowed more autonomy for nursing. As Matron of the hospital she was invited to play a part in Lewisham life and was a member of local professional womens’ groups.


Marjorie Bell transferred her knowledge and skills to differing contexts inspiring confidence in her staff to deal effectively with major trauma. Equally significant was her use of communication and interpersonal skills to enhance the voice of nursing in hospital management. However her story raises questions over the factors which affect the remembrance of some individuals and not others.


Sadie Marian Smalls

, EdD, RN

Assistant Director, Nursing

Kings County Hospital Center

Brooklyn, New York, USA



Aim of Study


To highlight Anna Caroline Maxwell, influence on the development of undergraduate and graduate nursing education and wartime nursing nationally and internationally. She was nicknamed “the American Florence Nightingale” because she accomplished many of the reforms in the United States as Florence Nightingale did in Britain, such as convincing the military that a permanent group of nurses under its auspice was essential if soldiers were to survive and establishing standards for nursing education.

Rationale and Significance


Nurses worldwide need to know and appreciate her influence not only on undergraduate and graduate nursing, wartime nursing in the United States, but also international nursing. She was an expert organizer, administrator and charter member of the American Society of Superintendents of Training School (1893), forerunner of the National League of Nursing, Nurses’ Associated Alumnae of United States and Canada (1897), forerunner of the American Nurses Association, the International Council of Nurses (1899), and instrumental in the establishment of the Army Nurses Corps (1901) and the first postgraduate nursing program (at Teachers College, Columbia University in 1901).


A historical descriptive approach was used to analyze her accomplishments. The framework used to guide the interpretation of the data consisted of concepts of professional associations and training schools of nursing; themes such as nurses as workers, socioeconomic and political issues, and reform, and variables such as curriculum, hospitals and activities of nurses are threads to evaluate her contributions to nursing. Primary sources included minutes of meetings, reports of committees and speeches from archival sources such as the Adelaide Nutting Collections (Teachers College, Columbia University); Mugar Memorial Archives (Boston University); Sophie Palmer Library (American Journal of Nursing); the National Archives and National Library of Medicine. Secondary sources consisted of historical nursing books, and articles from nursing journals


She was awarded an honorary Masters of Arts by the Board of Governors of Columbia University and buried with full military honors at the National Cemetery in Arlington, Virginia. The French Government bestowed the Medal of Honor for Public Health during World War I for her contribution to nursing throughout the world.


Anna Caroline Maxwell nursing activities were crucial to the growth of professional nursing nationally and internationally.

Concurrent Session 6

Session 6a: Rural and Remote Nursing


Elissa Lane Miller

, CNM, FNP, PhD.

Former Assistant Professor,

School of Nursing and Health Professions

Arkansas State University

Jonesboro, Arkansas, USA

501 268 6371



In the first decades of the twentieth century, American public health and medical officials recognized the necessity of improving the health and welfare of women and children. While both medical and public health groups believed that solving the “midwife problem” was the key to improved maternal-child care, they differed as to how the solution to the problem should look. The American Medical Association believed that elimination of midwives and replacement by physicians was the best solution. Public health officials believed that improved training and supervision of existing midwives was more practical. This study looks at the impact of those attempted solutions on a rural Appalachian community.


In 1924, Mary Breckinridge founded the Frontier Nursing Service (FNS) in rural Kentucky to demonstrate the effect that professionally trained nurse midwives could have in reducing the maternal-child mortality rates. Most of the scholarship on FNS has focused on the role of the nurse midwives, their challenges, successes and failures. Very little attention has been paid to the native midwives they supplanted.


Despite Breckinridge’s own claims to the contrary, there was initially a significant resistance to the British-trained midwives that Breckinridge imported. The local lay midwives that FNS midwives replaced were well integrated into the social and kin networks that dominated Appalachian society and their elimination was neither easy nor swift.


Using various original and secondary sources, such as letters, birth logs, oral histories, census records, biographies and official FNS records, this paper focuses on the native lay midwives that FNS replaced. Questions addressed include the following: What meaning did the practice of midwifery have for those who practiced it? What role did midwifery play in the integration of local society? What were the economic consequences of supplanting lay midwives with professional ones? And finally, how did lay midwives and their patients adjust to the increasing dominance of outside influences represented by FNS?


: Breckinridge and the Frontier nurses effectively demonstrated the ability of professionally trained nurse midwives to improve the survival of mothers and babies, but it did so at a price. Despite its success, Breckinridge’s demonstration project was never repeated elsewhere. The resulting disruption of indigenous networks of caring created a reliance upon outsiders for provision of health care, a problem which persists more than eighty years later.


Professor Ingunn Elstad

, R.N., Mag.Art.

Department of Health and Care Sciences,

University of Tromsø,

Tromsø, Norway

+47 77660273 Ingunn.elstad@uit.no


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