Nursing

Every day, care professionals and private individuals look after the physical and mental well-being of sick people on an inpatient, outpatient or home basis. In the 20th century, nursing changed fundamentally: The mechanisation of medicine has been advancing since the 1970s and has expanded the field of nursing tasks. Nursing diagnosis, patient monitoring or dealing with chronically ill patients are now taking their place alongside care-based activities. From the typically female auxiliary activity and the Christian service of love, an independent profession is developing with a diverse range of tasks that requires comprehensive training.

From vocation to profession

Around 1900, nursing was still firmly in the hands of church orders, which were often contractually bound to hospitals and provided almost all the nursing staff. Only at a slow pace would non-denominational schools go on to be established: In 1899, the Swiss Red Cross founded its first school for nurses in Berne. Here, women would learn how to be carers for society.

In the 20th century, the nursing profession underwent professionalisation and academisation. The process took a long time: It was not until 1992 that the training regulations and content for nursing professions were standardised in Switzerland. Seven years later, there were the first female nursing graduates. Today, nursing is taught at vocational schools, higher technical colleges and universities.

Excellent Sisters

In the 20th century, after successfully completing their training, nurses would still receive a nursing badge in addition to a diploma. It symbolises belonging to a particular school and establishes hierarchies. Auxiliary nurses or nurses-in-training do not wear badges. The emblem of the Red Cross Nursing School in Bern's Lindenhof bears the Latin lettering "Inter Arma Caritas" (Humanity between Arms) – the motto of the International Red Cross Committee until 1961.

Wax teaching aids

Not only doctors, but also nurses are required to recognise disease patterns. The necessary knowledge is imparted during training. Since the 19th century, mouldings have served as illustrative material: three-dimensional, coloured wax replicas that realistically reproduce diseases. In the 20th century, they were supplanted by colour photographs, but have experienced a renaissance in recent years. Mouldings often show skin diseases or also different types of infant stool, the assessment of which is important in paediatric nursing.

Status symbol or work tool

At the beginning of the 19th century, doctors used simple wooden tubes for the first time to listen to the human body. In the course of the 19th century, stethoscopes took on the form that is still common today: a chest piece, flexible tubes and two ear pieces. It becomes the identifying mark of the doctor, who always carries it about their person. As early as the 1930s, nurses also used it to routinely listen to blood pressure sounds. In the 1960s, a pastel-coloured "nursescope" was even developed especially for them.

How many nurses work at the Inselspital?

1852
18 nurses

1910
63 nurses

1928
80 nurses

1938
105 nurses

1948
148 nurses

1958
235 nurses (218 women, 17 men)

1989
938 nursing professionals (893 women, 45 men)
139 nurses
301 hospital assistants and nurses

Wardens, nurses, nursing staff

Until today, it is mostly women who practise the nursing profession. That was not always the case: In the pre-modern era, male "wardens" and monks also cared for the needy. It was not until the 19th century, when hospitals came into being and the bourgeois idea of the charitable woman was consolidated, and that nursing became a typically female activity. Until well into the 20th century, this can be seen in the term "nurse" as well as in professional clothing: It goes back to the costume of the nuns and deaconesses and symbolises selfless sacrifice. Today, carers have largely detached themselves from such idealised notions. But what has shaped nursing since the beginning is the lack of staff, the insufficient pay and the challenging working conditions.

Under the bonnet

The uniform of a "nurse" consists of a dress, an apron as well as a bonnet and a brooch. This so-called nurse's uniform shaped the image of the "nurse" for decades. It is only since the 1970s that the call for functional and especially hygienic clothing has become more pronounced. Traditional so-called "Sunday attire" remained in use until the 1980s, but then nursing staff began to wear standardised professional clothing. Today, it consists of trousers and a blouse-like smock.

When the patient rings twice ...

Nurse call systems, pagers and hands-free kits – today there are sophisticated systems for patients to reach their carers in an emergency. In the early 20th century, too, they were the first people to be contacted. However, the premises were already too large to keep an eye on all patients. The Inselspital, therefore, decided to install a professional call system: An electric switch would bring down the flap with the corresponding room number. This basic principle of hospital communication still holds true today.

How many carers work in Switzerland?

In Switzerland ...

... 214,000 people are employed in the care sector (nursing staff, assistants, midwives, health and social care assistants),
... four fifths of the positions are held by women,
... more than one third of the staff has a foreign nationality.

In Switzerland ...

... almost half of the staff (46 %) work in hospitals and special clinics,
... just over a third of the staff (36 %) work in old people's and nursing homes,
... just under one fifth of the staff (18 %) work in home care (e.g. Spitex),
... is what a qualified nurse earns, depending on professional experience, 4500 to 7500 francs per month.

Prepare, inform, protect

The bronchitis vessel is a water vaporiser that humidifies a room or the airways. In different versions, it remained in use until well into the 20th century. When using it, the nursing staff must perform different tasks: In addition to heating up and placing the vessel correctly, they instruct the patients and protect them from getting wet and burnt. The exact procedure is laid down in care manuals.

Emancipation through mechanisation

From the second half of the 20th century onwards, hospitals created technically complex apparatus and set up intensive care units. This mechanisation was considered an emancipatory step for care. At the same time, however, the professional role began losing its autonomy, as doctors had to sign off on many highly specialised activities. Cooperation between nurses, doctors and technical staff became increasingly important. The innovations eld to an expansion in the scope of duties: Nurses were no longer exclusively responsible for basic care, but rather monitored patients' vital functions and operated the new equipment. The necessary technical know-how was imparted during internal hospital training courses. These courses exemplified the professionalisation that has characterised nursing since the 1980s.

Ventilation

In 1958, the Inselspital established the first intensive care unit in Switzerland. Machine ventilators, such as the so-called Engström respirator, were used there. The operation of complex equipment was the responsibility of the nursing staff, who continued to provide basic care for the patients and look after the relatives. Many nurses identified with this medical progress, but there were also critical voices that feared a "dehumanisation" of nursing.

Precise action

When intensive care medicine became established in the second half of the 20th century, specialisation occurred within nursing. Nurses working in intensive care units require additional training and were, therefore, highly regarded. One of their tasks was to operate suction equipment to keep the airways clear. To do this, they had to interrupt artificial respiration in intubated patients. Fast, and at the same time, cautious action was required.

Privacy and taboos

Primary care for sick people and people in need of care remains an important part of care work. If patients need assistance with eating and drinking, with daily hygiene or with excretions, and the nursing staff will help. In doing so, they get very close to the patients, but at the same time have to preserve their privacy. This requires a lot of sensitivity and skill, including due to spatial conditions. Carers must also not show any sign of disgust. These are the challenges that nursing staff face every day. In doing so, they have to circumvent existing social conventions, because taboos around human excretions, physical proximity and distance cannot be observed in care.

Food and drink

If people in need of care are not able to feed themselves independently and with conventional dishes, they need support. Beaker cups are specially made for this purpose: The patient can drink in a semi-recumbent position without spilling anything. The handle on the side allows the patient to hold the cup in his or her own hand. If the handle is placed at the back, the caregiver guides the cup to the mouth. Beaker cups are often white, signalling clinical purity.

Support with a subject considered to be taboo

If necessary, the nurse will help with going to the toilet. Commodes – or aids known by similar names – have been part of nursing care since the 19th century. For a long time, they were made of wood or porcelain. It was only with the efforts to improve hygienic conditions that the materials changed at the end of the 19th century: Commodes were intended to be easy to clean and germ-free. Newer models are usually made of easy-to-clean steel and plastic. They also have fixed castors, which early models did not have.

Not all urine bottles are the same ...

Urine bottles have been part of everyday nursing practice since the 19th century. Around 1900, there were different models whose advantages were known to nurses. You knew that bottles with an elongated neck were for men, while those with an oval opening were for women. Textile covers were comfortable, but unhygienic if used several times. Tin models are prone to crusting, while glass bottles were easy to clean and hygienic. Today, urine bottles are made of plastic – they are robust and cheap to produce.

Washed and clean

If the patients were unable to clean themselves, nursing staff would assist or take over this task. There were standardised procedures: The nurse would dip the washcloth into the washbasin, starting at the head and ending at the patient’s intimate area. But even such a fundamental activity became the subject of change: From the 1970s onwards, new concepts, such as basal care, led to an adaptation of the approach taken to body washing. The materials also changed: Today, disposable flannels made of cellulose are often used. They are practical and hygienic, but some carers do not like to use them as the patient is less used to them.

Touching and delimiting

Without physical contact, nursing activities would not be possible. No other professional group in medicine works as close to the whole human body as nursing. Unlike specialists such as gynaecologists, nurses touch the whole body and not just certain specialist areas. If a person needs assistance with dressing or undressing, personal hygiene or assuming a desired position, close physical contact cannot be avoided. The taboos of everyday life are thus inevitably lifted. To meet this challenge, communication is as important as touch itself.

An intimate intervention

If a patient cannot urinate, a catheter is used to access the bladder. Catheters were first made of animal skins, then later from metal; from the 19th century, they were made of rubber and today of PVC, latex or silicone. This is to reduce the high risk of infection. Placing a urinary catheter is a very intimate procedure that should only be performed by properly trained nurses.

Lying down and in storage

Until well into the 20th century, female patients lay in bed for long periods of time. This practice could cause pressure ulcers to form. In order to prevent these and to position parts of the body without contact, the nursing staff use air cushions. The first models were probably made of leather or animal bladders. Since 1839, it has been possible to produce elastic, dimensionally stable rubber from natural rubber. Such rubber cushions quickly found their way into care and remained in use until the 1990s.

Protection or proximity

To protect themselves from infection, carers would put on disposable gloves. It was not until the AIDS pandemic in the 1980s that latex gloves became standard. Previously, the nurse worked with thin plastic gloves during intimate care or in the intensive care unit. To this day, disposable gloves remain controversial because of their lack of proximity. For certain nursing activities, such as personal hygiene for babies, the nursing staff sometimes do without.

Selected bibliography

Artner, Lucia; Atzl, Isabel; Depner, Anamaria et. al. (Hg.) (2017): Pflegedinge: Materialität in Pflege und Care, Bielefeld.
Braunschweig, Sabine (Hg.) (2006): Pflege – Räume, Macht und Alltag, Zürich.
Hallett, Christine E.; Nolte, Karen (2019): Crossing Boundaries: Nursing, Materiality and Anaesthetic Practice in Germany and Britain, 1846-1945, in: European Journal for Nursing History and Ethics, S . 40-66
Joris, Elisabeth; Roth, Sabina; Bott, Sandra; Nydegger, Jolanda (Hg.) (2021): PflegeKrisen, Traverse: Zeitschrift für Geschichte, Zürich.
Rüedi, Elisabeth (2008): Die Pflege und das Pflegemanagement in ständigem Wandel : Geschichte der Krankenpflege im Inselspital 1954-2004, Zürich.

Nursing

Excellent Sisters

"... always in the way"

Wax teaching aids

"... not the smartest"

Status symbol or work tool

"... an important working tool"

How many nurses work at the Inselspital?

Under the bonnet

"... we were proud"

"... it simply belonged to it"

When the patient rings twice ...

"... always present"

Does the nursing staff have enough time?

How many carers work in Switzerland?

Prepare, inform, protect

"... often burnt"

Ventilation

"... faster away from the machine"

Precise action

"... into the most intimate zones of the face".

Food and drink

"... sorting out your own drink..."

Support with a subject considered to be taboo

"...pissing contest"

Not all urine bottles are the same ...

"... not exactly relaxing"

"... pas vraiment relaxant"

Washed and clean

"... to make the patient feel better"

An intimate intervention

"... false opening"

Lying down and in storage

"... don't inflate too much"

Protection or proximity

"... all the trial and error"

Selected bibliography