Indigenous caregivers: Reconsidering nursing traditions
Jul 03, 2017, By: Lydia Wytenbroek, MA, BA, BSN, RN, Helen Vandenberg, PhD, RN
This year marks the 150th anniversary of Confederation, when the provinces of Canada (Ontario and Quebec), New Brunswick and Nova Scotia came together to form the Dominion of Canada. Of course, the land we now call Canada had a complex history and peoples long before 1867. Nursing in Canada also has a much longer history than is typically acknowledged, predating Florence Nightingale and her health-care reforms. In this article, we offer three examples of how historical knowledge has produced new understandings of that history.
Histories of Canadian nursing often point to the French Catholic nursing tradition and the British nursing apprenticeship tradition. Neglected from this narrative until recently are Indigenous healing traditions and health practices. Long before European settlement in Canada, Indigenous healers and midwives occupied important caregiving roles in their communities (Benoit & Carroll, 2005, p. 27). These healers had extensive knowledge of medicinal plants and knew how to harvest, prepare and administer them to treat ailments. Historian Kristin Burnett found that Indigenous women healers in western Canada prior to the turn of the 20th century also played a vital role as nurses and midwives in settler societies. For example, a Saskatchewan settler wrote in 1833 that a Blackfoot woman had cured his sister-in-law of dysentery by giving her a tea made from white prairie flowers, after a local doctor had been unable to heal her (Burnett, 2010, p. 60).
After Confederation, the federal government aggressively pursued a policy of assimilating Indigenous Peoples and eradicating their cultures, which included efforts to suppress their healing knowledge and practices (Lux, 2016, p. 5). As well, Indigenous women were largely barred from entering nurse training schools until the 1930s, highlighting the lack of equal opportunities that existed for those who wished to pursue nursing work. The history of Indigenous caregivers challenges us to think beyond the history of French Catholic and British nursing traditions.
Catholic nursing sisters: Reconsidering nursing autonomy
It is common to hear that the nurses of the past had little autonomy and worked under the control of physicians or hospital boards. Yet the accomplishments of many of the first nursing sisters in Canada counter this perspective. The Catholic nursing sisters built a vast network of nurse-run hospitals, beginning in 1637 — 230 years before Confederation — when three Augustinian nuns established Hôtel-Dieu de Québec, in Quebec City. By 1947, nursing sisters operated at least 146 hospitals across Canada (Paul, 2005, p. 125). Prior to the nursing tradition established by Nightingale, religious women wielded significant power and authority as hospital owners, architects, treasurers and managers.
Nursing sisters were guided by a distinct ethos of service, and their religious identities provided them with opportunities to emerge as leaders at a time when women had few other employment options. For example, Mother Joseph, born in Quebec in 1823, designed and built more than two dozen health centres in the Pacific Northwest. She had learned carpentry from her father and joined a Catholic order so she could use her skills professionally. She oversaw every facet of hospital construction, often living in a shack on hospital construction sites so she could give direction to workmen (McEvoy, 2008, pp. 47-51, 55-58).
Catholic hospitals were founded as charitable institutions and nursing sisters put mission before profit. They were highly active in charity work and often implemented subscription systems. For example, nursing sisters in Vancouver sometimes issued a slip that guaranteed access to hospital care in exchange for a donation to the hospital (Providence Health Care, 2002).
Nursing sisters viewed their work as a spiritual ministry and found creative ways to push against the hierarchical boundaries of the church, where women were expected to be subservient to bishops and priests (Wall, 2005).
Apprenticeship training: Reconsidering nursing education
Nightingale’s apprenticeship training model solidified nursing as a respectable occupation for women. Before this model was implemented, hospital care was carried out by a range of available ward attendants — “male and female, religious and lay, paid and unpaid, skilled and unskilled” caregivers (McPherson, 2005, p. 74). In some hospitals, patients had to rely on one another for care. As hospital and scientific medicine advanced in the late 1800s, hospital care became focused on treatment and therapy (McPherson, 2005, p. 74). During this time, apprenticeship training became popular as a way to elevate the status of nursing and attract middle-class paying patients. The introduction of trained nurses was instrumental in elevating the status of hospitals — from being associated with death and dying to being perceived as providing treatment and hope.
By 1900, hospitals in Canada had started to educate and employ trained nurses. St. Catharines General and Marine Hospital in Ontario established the first hospital training school for nurses in Canada in 1874 (Gibbon & Mathewson, 1947). Under the apprenticeship system, thousands of students were dependent on hospitals to provide them with training, while hospitals depended on students to staff the wards (McPherson, 2005, p. 79).
The training was demanding. Students worked long hours, often six days per week, with little pay. When they transgressed the strict rules, they faced disciplinary action. A senior student at Vancouver General Hospital was temporarily suspended in 1959 for kissing a man outside the hospital (McPherson, 1999). Students often looked for ways to rebel. At Kingston General Hospital in the 1920s and 1930s, they kept a secret book of their rule-breaking exploits, such as racing laundry baskets through the underground hospital tunnels, stealing roast chickens from the hospital kitchen and climbing out of the windows in their residence after curfew (Wishart, 2005, p. 185).
In 1919, the University of British Columbia established the first baccalaureate nursing program in Canada (Zilm & Warbinek, 1994). Students spent the first and last years of the program in the university and the middle years training at local hospitals. The first integrated nursing degree program was started at the University of Toronto in 1942. In this program, university nursing faculty had control over nursing education in the university and the teaching of nursing practice within the hospitals (Kirkwood, 2005, p. 193). As nursing education transitioned from hospitals to educational institutions, nursing leaders were able to set and control educational standards (Kirkwood, 2005, p. 195).
Today, Canada is one of the few countries in the world requiring a bachelor’s degree for entry to practice as a registered nurse. Academic nursing education provides an ideal platform for students to develop leadership and decision-making skills.
Nursing education has undergone significant changes in the past 150 years, yet there is still much to be done to prepare nurses for the challenges of the future.
Benoit, C., & Carroll, D. (2005). Canadian midwifery: Blending traditional and modern practices. In C. Bates, D. Dodd, & N. Rousseau (Eds.), On all frontiers: Four centuries of Canadian nursing (pp. 27-41). Ottawa: University of Ottawa Press.
Burnett, K. (2010). Taking medicine: Women’s healing work and colonial contact in Southern Alberta, 1880-1930. Vancouver: UBC Press.
Gibbon, J. M., & Mathewson, M. S. (1947). Three centuries of Canadian nursing. Toronto, ON: The MacMillan Company.
Kirkwood, L. (2005). Enough but not too much: Nursing education in English language Canada (1874-2000). In C. Bates, D. Dodd, & N. Rousseau (Eds.), On all frontiers: Four centuries of Canadian nursing (pp. 183-195). Ottawa: University of Ottawa Press.
Lux, M. K. (2016). Separate beds: A history of Indian Hospitals in Canada, 1920s-1980s. Toronto: University of Toronto Press.
McEvoy, J. (2008). The life and destruction of Saint Mary’s Hospital. New Westminster, BC: St. Mary’s Health Foundation.
McPherson, K. (1999). ‘The case of the kissing nurse’: Femininity, sexuality, and Canadian nursing, 1900-1970. In K. McPherson, C. Morgan, & N. M. Forestell (Eds.), Gendered pasts: Historical essays in femininity and masculinity in Canada (pp. 179-198). Don Mills, ON: Oxford University Press.
McPherson, K. (2005). The Nightingale influence and the rise of the modern hospital. In C. Bates, D. Dodd, & N. Rousseau (Eds.), On all frontiers: Four centuries of Canadian nursing (pp. 73-87). Ottawa: University of Ottawa Press.
Paul, P. (2005). Religious nursing orders of Canada: A presence on all western frontiers. In C. Bates, D. Dodd, & N. Rousseau (Eds.), On all frontiers: Four centuries of Canadian nursing (pp. 125-138). Ottawa: University of Ottawa Press.
Providence Health Care. (2002). Emilie Gamelin and the Sisters of Providence — St. Paul’s Hospital Vancouver [Video file]. Sisters of Providence. Retrieved from https://youtu.be/nfa7gTltHuA
Wall, B. (2005). Unlikely entrepreneurs: Catholic sisters and the hospital marketplace, 1865-1925. Columbus, OH: Ohio State University Press.
Wishart, J. (2005). “We have played while we worked and worked while we played.” In C. Bates, D. Dodd, & N. Rousseau (Eds.), On all frontiers: Four centuries of Canadian nursing (p. 185). Ottawa: University of Ottawa Press.
Zilm, G., & Warbinek, E. (1994). Legacy: History of nursing education at the University of British Columbia, 1919-1994. Vancouver: UBC Press.
Advancing historical scholarship
A member of CNA’s Canadian Network of Nursing Specialties, the Canadian Association for the History of Nursing (CAHN) was founded in 1987 to promote interest in the history of nursing and advance historical scholarship in nursing. CAHN’s members include practising and retired nurses, students, academic historians and nurse researchers.
Scholars argue that studying history develops critical thinking, fosters a professional identity and enables nurses to contextualize nursing practice. In addition, the actual process of historical research, which involves constructing arguments from large amounts of raw data, is an important skill that is applicable to nursing practice. When nurses perform a nursing assessment, they collect information about the patient from multiple sources and use a variety of techniques to identify changes in the patient’s health status and clearly communicate this information to other health-care professionals. Historical study can assist nurses to hone these skills because it requires synthesis, analysis, concise argumentation and clear communication.
In a position statement published in 2007, CNA called upon nurses, researchers, educators and nursing organizations to continue to preserve, examine and disseminate Canadian nursing history.
In 2015, the Canadian Association of Schools of Nursing identified history as an essential component of baccalaureate nursing education in its report National Nursing Education Framework.
As a new cohort of nurses begins to take on the task of leading the profession, CAHN members hope to build and sustain support for nursing history research and education. It will be important to carry on this work with the involvement and support of the next generation.
CAHN has formed an education committee in response to requests from educators for resources that will enable them to incorporate nursing history in their courses. The committee’s plans include creation of a video about nurse leaders and a timeline of important nursing events. These resources will be made available on the CAHN website.
CAHN also presents two major awards each year: the Allemang Scholarship for graduate students who are studying nursing history and the Vera Roberts Award for nurse historians whose work focuses on outpost nursing and nursing in regions north of the 60th parallel.
Lydia Wytenbroek, MA, BA, BSN, RN, is a PhD candidate, graduate program in history, York University.
Helen Vandenberg, PhD, RN, is an assistant professor, college of nursing, University of Saskatchewan.