Marit Kirkevold
14.1 Introduction
This chapter will start with a brief overview of the early development of nursing as a profession and will locate this development within the Norwegian health and soci- etal contexts. This overview will be followed by a description of the development of higher education for nurses both outside and within academic institutions. A review of the development of nursing research will follow, and the chapter will end with a discussion of future prospects.
14.2 The Early Beginnings of the Nursing Profession
The development of nursing as a profession came to the fore in parallel with many other essential changes occurring in the newly independent country of Norway, which gained its independence from Denmark in 1814 but then entered into a union with Sweden, which lasted until 1905. The building and growth of the new country spurred urgent political and social initiatives seen as essential to ensure the success of the new country. Also, in 1814, the first medical faculty was established at the University of Oslo in order to provide the independent country with its own physi- cians [1]. This was followed in 1826 with the establishment of the National Hospital [1, 2], which has been the leading teaching and research hospital in medicine—and, later, in clinical nursing—since its inauguration (see Chap. 15). (For an overview of the developments, see Fig. 14.1)
The provision of health-care services gained prominence during these early for- mative years as both hospitals and home care services for the sick and poor were
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General socio-political developmentsNursing-related developments 1814 1900
The first Norwegian nursing school established in 1868 (Christiania Diachonisse nursing school) Norwegian nurses association (NNA) established 1912. Main focus: Regulation of education of nurses and work welfare for members NNA establishes its School for continuing education for nurses for nurse leaders and teachers (and later health visitors) in 1925
1925
Norwegian women’s public health association formed 1896. Organized TB care across Norway, established nursing schools and public health initiatives.
The Faculty of Medicine established at University of Oslo (UiO) in 1814 (1st in Norway)Norway independent of Denmark 1814– initiation of national building 1850 1950
The Norwegian National hospital was established 1826 (medical education/ research) 1975Academic nursing studies at university level established at University of Tromsø 1977, Bergen 1979 and Oslo 1985. 1st professor in nursing 1979 University of Bergen, 2nd professor 1985 UiO.NNAs School for higher education in nursing initiated nursing research course (1954) and Helga Dagsland conducts first nursing research study 1953
Medicine and health-related developments Marie Spångberg, 1st woman physician 1893 General voting rights for women 1913
Norwegian association for women’s rights established 1884 Many rights for women established 1900-1940: Right to work (first unmarried and widows, later married women), better working conditions and pay, right to conduct business and private ownership1st women representative in National assembly 1922. Women may become ministers. Law of equal rights 1978 Fig. 14.1Overview of historical development 1814–1975 M. Kirkevold
developing. Tuberculosis was a pervasive and feared disease affecting almost every family across the country, and the health-care system was almost non-existent [1].
The pressing need for trained nurses grew, and in 1868, the first nursing school was established in Christiania (later renamed Oslo), inspired by the principles and orga- nization of the German Kaiserswerth training for nurses [3]. This school was soon followed by a great number of other nursing schools established by voluntary orga- nizations and hospitals [4, 5].
Not long after the first nursing school was established, a significant event in the development of nursing occurred. The Women’s Association for Public Health (N.K.S.) was established in 1896 [1, 6]. This association grew quickly and became an important force for development of women’s public health initiatives across the country. It gave women an opportunity to organize and take part in the social con- struction of the independent country. Its founders were women close to the political establishment in Norway, and it also had close ties to the newly established Norwegian Association for Women’s Rights, founded in 1884 [7, 8]. These ties pro- vided N.K.S. with political clout, and it became an important vehicle for women’s political influence [1, 6]. One of its first goals was to initiate a systematic battle against tuberculosis (TB). Through the work of hundreds of women in local chap- ters across Norway, the women secured finances to build and run sanatoriums for people with TB [1, 6]. Another closely related social issue at the time, which the association set out to address, was the need for qualified nurses; consequently, N.K.S. established at least two nursing schools—one in 1898 and one in 1919 [4, 6].
The N.K.S. was not the only association to be engaged in nursing education and care. The Norwegian Red Cross and the Association Against Tuberculosis (later renamed the National Association for Public Health) also launched similar initia- tives [5]. In contrast to the Women’s Association for Public Health, both Red Cross and the Association Against Tuberculosis were run by men. Red Cross supported education of nurses locally and abroad from the early 1890s and started its own school in 1919 [5]. From a feminist perspective, it is interesting to note that the Association Against Tuberculosis was launched about 25 years after the N.K.S. by a male physician even though N.K.S. had decided, as its main aim, to fight tubercu- losis. This overlap might reflect the harsh disagreements at the time regarding whether nurses needed a 3-year education aligned with Florence Nightingale’s ide- als or not [4]. The N.K.S. provided early support of this ideal, for which the Norwegian Nurses’ Association (NNA) fought from its inception [4], but the NAA experienced fierce opposition from the medical profession [4, 5]. In these early years, there were strong links between the women’s liberation movement, the fight for education and professional vocations for women and the education and develop- ment of the nursing profession in Norway [4, 5]. The NNA was established in 1912, the year before women got full voting rights in Norway [4, 5]. This was a time of increasing opportunities for Norwegian women and led to cries for the rights of women to have paid work, complete higher education, have an independent finan- cial status (whether unmarried or married) and establish and conduct business.
These were not self-evident rights for women at the time, and they were gained gradually through political, social and cultural battles [7, 8]. The NNA was founded
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within this context, and its founders—including the first president, Bergljot Larsson—were clearly influenced by the women’s liberation movement [4, 5]. The NNA’s main goal was to ensure the quality of the nurses providing care for the sick and poor, and it saw education as an essential tool to ensure this. From the start, they fought to ensure that Norwegian nurses would be educated based on the principles laid down by Florence Nightingale, who had established the first formal education for nurses in London in 1860. A 3-year integrated education programme required for authorization as a registered nurse was the NNA’s first and foremost goal for which they fought until the requirement finally was enacted by the government in 1948 [4]. By that time, most nursing schools already offered 3-year programmes as membership in NNA required such programmes based on the Florence Nightingale- inspired programme developed by NNA in 1919 [4, 5]. Nevertheless, the formal acceptance, by law, of the Norwegian government was an important achievement for the NNA and the nursing profession.
14.3 Higher Education for Nurses
Higher education for nurses was initiated in 1925, when the NNA established its own school for further education in nursing, initially called ‘The Continuing School for Nurses’. At the start, the school provided brief courses in nursing leadership, pedagogy for nurse supervisors and teachers and social care for nurses working in the community [4]. Over time, however, the school developed longer programmes in nursing leadership and nursing education. In 1965, the school was renamed the Norwegian School of Advanced Education in Nursing. The school qualified the nursing leaders within nursing services and education until the school was trans- ferred to the University of Oslo in 1985 as the Institute for Nursing Science.
Many of the school’s educators sought higher education in nursing abroad, par- ticularly in the United States and in Great Britain [4, 5, 9]; therefore, the educational programmes were influenced by the development of nursing internationally and gradually developed into academic education and leadership within nursing science [9]. The unique position of the NNA school is reflected by the central position it had in ensuring university education in nursing in Norway. One of its prominent educa- tors and head of school between 1979 and 1985, Kjellaug Lerheim, was instrumen- tal in developing the underlying documents for the political processes that eventually led to decisions to establish higher education for nurses at the University of Tromsø in 1977, at the University of Bergen in 1979 and finally at the University of Oslo in 1985. This political work, carried out by NNA, lasted for many years. Actually, the first rudimentary idea about an advanced university education in nursing was launched in the early 1920s and Nordic collaboration was discussed among the leaders of the Northern Nurses Federation for some years. However, the idea was relinquished in favour of national plans for higher education for nurses [5]. It was not until the 1960s and 1970s that this work emerged on the national political scene in Norway [4, 5]. The idea gained no immediate support from the authorities or the leadership at the universities or the medical faculties. Three different panels or work
M. Kirkevold