Barbra Mann Wall

Histories of nursing: The power and the possibilities

This article challenges the dominant paradigm of understanding the history of nursing as only that of relative powerlessness. By moving away from the stance of educators deeply concerned about the inability of the profession to gain control over entrance requirements and into the realm of practice, we use examples from our own work to discuss alternate histories of power. We acknowledge historical circumstances of invisibility and gender biases. But we argue that when we look at the history of practice, we see as much evidence of strength, purpose, and successful political action. Finally, we call for an acknowledgement of the rich and complex nature of the many different histories we can tell in nursing. And we suggest that an admitted inability to advance in one area of the discipline has not meant an inability to move in others.

Definite lines of influence: Catholic sisters and nurse training schools, 1890-1920.

BackgroundStandard histories of the nurse training school movement have focused on national leaders and organizations and have generally not included Catholic sisters, even though nuns had established approximately 220 nursing schools by 1915. ObjectivesThis study asks how Catholic sisters used their distinct understanding of nursing to shape their nursing schools and the nurse training movement in the United States between 1890 and 1920. MethodHistorical methodology draws upon primary sources in archives of three women’s religious congregations, the Catholic Health Association, and the University of Notre Dame. These include nuns’ constitutions and letters, hospital chronicles, journals, minutes of meetings, training school records, annual reports, yearbooks, census records, and educational reports. Secondary sources include nursing, hospital, religious, and labor histories. ResultsCatholic sisters adapted their nursing to bring it into line with modern society by establishing nurse training schools for both religious and secular women. This legitimized their nursing practice and enhanced their influence with students, physicians, and hospital groups. As nuns admitted laywomen into their schools and worked toward accepted standards of professionalization, they stamped their distinct understanding of nursing onto secular society. DiscussionThe development of professionalized nursing drew Catholic sisters’ schools toward common goals with non-Catholic programs. On the other hand, the sisters’ historical construction of nursing in the 19th century, their unique relationship with physicians, and the obstacles they faced later, such as the Roman Catholic clergy’s attempt to control evaluation processes, indicate a distinct approach to Catholic nursing. Questions remain as to whether nuns could hold onto their authority later in the 20th century.

Religion, gender, and autonomy: a comparison of two religious women's groups in nursing and hospitals in the late nineteenth and early twentieth centuries.

Modern historical research of women and nursing has largely neglected the role of religious groups, particularly in the American frontier. The image of women at the end of the 19th century was one of submission to male authority and confinement to the domestic sphere. However, in the pluralistic West, a variety of organized religious women built and administered hospitals, initiated professional nursing, and provided effective health care services. This article compares cases of Catholic nuns and Mormon women as exemplars in a conceptual context of religious devotion, gender roles, and autonomy among womens religious organizations at the dawn of the 20th century.

Distinct enough? A national examination of Catholic hospital affiliation and patient perceptions of care.

BACKGROUND Catholic hospitals play a critical role in the provision of health care in the United States; yet, empirical evidence of patient outcomes in these institutions is practically absent in the literature. PURPOSE The purpose of this study was to determine whether patient perceptions of care are more favorable in Catholic hospitals as compared with non-Catholic hospitals in a national sample of hospitals. METHODOLOGY This cross-sectional secondary analysis used linked data from the 2008 American Hospital Association Annual Survey, the 2008 Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, the 2008 Medicare Case Mix Index file, and the 2010 Religious Congregations and Membership Study. The study included over 3,400 hospitals nationwide, including 494 Catholic hospitals. Propensity score matching and ordinary least-squares regression models were used to examine the relationship between Catholic affiliation and various HCAHPS measures. FINDINGS Our findings revealed that patients treated in Catholic hospitals appear to rate their hospital experience similar to patients treated in non-Catholic hospitals. Catholic hospitals maintain a very slight advantage above their non-Catholic peers on five HCAHPS measures related to nurse communication, receipt of discharge information, quietness of the room at night, overall rating, and recommendation of the hospital; yet, these differences were minimal. PRACTICE IMPLICATIONS If the survival of Catholic health care services is contingent upon how its provision of care is distinct, administrators of Catholic hospitals must show differences more clearly. Given the great importance of Catholic hospitals to the health of millions of patients in the United States, this study provides Catholic hospitals with a set of targeted areas on which to focus improvement efforts, especially in light of current pay-for-performance initiatives.

Conflict and Compromise: Catholic and Public Hospital Partnerships

This article analyzes the tensions and uneasy negotiations, based on a case study, that occurred among Catholic sisters, administrators, bishops, physicians, and the Vatican for more than seven years at a hospital in Austin, Texas. Here, the largest health care system in the city, which was Catholic, joined with the local public, tax-supported hospital that provided the majority of reproductive health care services in the region. A clash resulted over whether the hospital could continue providing sterilization and contraceptive services to its primarily poor patients. This article examines the fierce debates that occurred, especially over emergency contraception and attempts to develop creative solutions after a hierarchical crackdown from the Vatican. The end result was a compromise that included the creation of a “hospital within a hospital.”

The pin-striped habit balancing charity and business in Catholic hospitals, 1865-1915.

BackgroundNursing literature seldom examines Catholic sisters as entrepreneurs competing in the hospital marketplace, even though they established hospitals throughout the United States in the late 19th and early 20th centuries. ObjectivesThis study examines the tension between hospitals as businesses and charities by asking how nursing sisters, who took vows of poverty, could build impressive hospital networks. What links did they forge to make hospital building possible? MethodHistorical methodology is used which draws upon primary sources in archives of three women’s religious congregations. These include nuns’ constitutions and letters, hospital chronicles, journals, minutes of meetings, annual reports, and census records. Secondary sources include nursing, hospital, religious, and economic histories. ResultsCatholic sisters’ entrepreneurial activities were pragmatic adaptions that reflected their commitment to their nursing and hospital establishments. They raised money and formed alliances not to build personal fortunes but to build religious values. Their entrepreneurship and spirituality worked together. DiscussionSister-nurses’ viewed their actions as doing what was necessary to their mission. A finacially stable hospital, with it’s large patient population, enhanced the social and spiritual importance of nun’s work. Yet, the broad-based corporate culture of Catholic hospitals still needs further study.

Healing after disasters in early-20th-century Texas.

This historical study analyzes 2 disasters in Texas in the early 20th century: the 1937 school explosion in New London and the 1947 Texas City ship explosion. Disaster narratives and commemoration activities are examined as means of healing and restoration after a catastrophic event. Specifically, this article discusses contextual factors of time and place, Coastal and East Texas between 1937 and 1947, and shows how these factors shaped the ways in which people made sense of their disaster experiences. This included not only the influence of geography but also economics, social position, racial characterizations, and religious beliefs. The article also considers conflicting and biased factors that can occur regarding time and place and how these factors influenced narrative constructions.

Remaking the American Patient: How Madison Avenue and Modern Medicine Turned Patients Into Consumers

medicine, involving patients as consumers of health care, has its roots, instead, in the early 20th century. Tomes argues, “Long before the 1970s, [patients] began to seek out information, ask questions, and challenge medical authority; in the process, they started to reshape the culture of American medicine” (p. 3). Tensions developed, however, over the trends of American individualism and autonomy versus deference to scientific authority. Tomes uses a wealth of primary sources in the form of personal, organizational, government, legislative, newspaper, and business records to make her argument. Of great interest to this reviewer is how she weaves legislative acts and Supreme Court decisions into her analysis of different policy-making levels. She admits that her sources are “closely associated with educated middleclass professionals” (p. 14). Furthermore, as she states, there are no real villains in her story. She does not “worship” in the “church of the free market” (p. 15), but it is clear that Tomes favors empowering patients. She convincingly argues that physicians generated a medical consumerism through their value of (a) the doctor–patient relationship so that Americans expected more from their doctors and (b) an individualism that allowed “uneven standards of care and forms of medical entrepreneurship” that “seemed more commercial than professional” (p. 9). Remaking the American Patient: How Madison Avenue and Modern Medicine Turned Patients Into Consumers

Nurses and Disasters: Global, Historical Case Studies

The book addresses such questions as: How did local, regional, and national communities mobilize for emergency care? What was the role of local nurses in emergency care after disasters? What was the role of the national or international Red Cross, local and federal governments, physicians, nurses, and other first responders? What was the impact of social attitudes and issues of race, class, and gender on the ways nurses and other health care professionals reacted to the disasters? How did unpreparedness for the type or scope of the disaster affect the response? The book will be of value to a wide variety of undergraduate and graduate students in nursing, social work, history, health policy, womens studies, public health, and urban studies.

Women religion and maternal health care in Ghana 1945-2000.

This article documents the historical factors that led to shifts in mission work toward a greater emphasis on community health for the poor and most vulnerable of society in sub-Saharan Africa after 1945. Using the example of the Medical Mission Sisters from Philadelphia, Pennsylvania, and their work in Ghana, we challenge the conventional narrative of medical missions as agents of imperialism. We assert that missions-particularly those run by Catholic sister physicians, nurses, and midwives-have changed over time and that those changes have been beneficial to the expansion of community health, particularly in the area of improvement of maternal care.