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THE HISTORY OF SPANISH NURSING (1953-1980): INTRODUCTORY NOTES

HISTORIA DE LA ENFERMERÍA ESPAÑOLA (1953-1980): NOTAS INTRODUCTORIAS

ABSTRACT

A historical-social documentary study aiming to analyze the history of Nursing in Spain, in the period 1953 - 1980. Undertaken between September and December 2014 through consultations with archive services, newspapers, legislation, specialized journals and academic works. This historical period corresponds to the unification of the teaching of practitioners, midwives and nurses (1953) and to the approval of the standards of the title of Sanitary Technical Assistant with Diploma in Nursing (1980). Thematic analysis was used for understanding the meanings and thus to (re-)construct part of this history. The empirical material revealed that the Real Escuela de Enfermeras de Santa Isabel de Hungria is considered the pioneer within the anglo-saxon model, that Spanish Nursing results from the fusion of three professions (practitioners, midwives and nurses) and training separated by sex was striking. Finally, it is concluded that the trajectory of Spanish Nursing towards the level of a graduate profession was long and arduous.

DESCRIPTORS:
Nursing; History of nursing; Teaching; Health personnel; Spain

RESUMEN

Investigación documental y socio-histórica que objetivó analizar la historia de la Enfermería en España de 1953 a 1980. Fue elaborado entre septiembre y diciembre de 2014, a través de consultas realizadas en los servicios de archivos, periódicos, legislaciones, revistas especializadas y trabajos académicos. El recorte histórico inicial, corresponde a la unificación de las enseñanzas de los practicantes, matronas y enfermeras (1953) y el final a la homologación de las normas de título de Ayudante de Técnico Sanitario con Diploma en Enfermería (1980). Se utilizó análisis temático para la comprensión criteriosa y sistémica de los significados, para así (re)construir parte de esa historia. El material empírico reveló que la Real Escuela de Enfermeras de Santa Isabel de Hungría es considerada la pionera en el modelo anglosajón; la Enfermería española resulta de la fusión de tres profesiones (practicantes, matronas y enfermeras) y que fue significativa la formación separada por sexo. Finalmente, se concluye que la trayectoria de la Enfermería española fue larga para llegar al nivel superior.

DESCRIPTORES:
Enfermería; Historia de la enfermería; Enseñanza; Profesional de salud; España

RESUMO

Estudo histórico-social documental com o objetivo de analisar a história da Enfermagem na Espanha, no período de 1953 a 1980. Elaborado entre setembro e dezembro de 2014 através de consultas aos serviços de arquivos, jornais, legislação, revistas especializadas e trabalhos acadêmicos. O recorte histórico corresponde à unificação dos ensinos de praticantes, matronas e enfermeiras (1953) à homologação das normas do título de Ajudante Técnico Sanitário em Diplomado em Enfermagem (1980). Utilizou-se a análise temática para compreensão dos significados e assim (re)construir parte dessa história. O material empírico revelou que a Real Escuela de Enfermeras de Santa Isabel de Hungria é considerada a pioneira no modelo anglo-saxão, que a Enfermagem espanhola resulta da fusão de três profissões (praticantes, matronas e enfermeiras) e que foi marcante a formação separada por sexo. Por fim, conclui-se que longa e árdua foi a trajetória da Enfermagem espanhola rumo ao patamar de profissão de nível superior.

DESCRITORES:
Enfermagem; História da enfermagem; Ensino; Pessoal de saúde; Espanha

INTRODUCTION

In Spain, the Real Escuela de Enfermeras de Santa Isabel de Hungria (1896), founded by the surgeon Federico Rubio y Gali, in the Instituto Quirúrgico de Terapéutica Operatoria, Madrid, is held as the country's first in the anglo-saxon model and set up with secular professional training in mind.11. Domínguez SQ. Del practicante a la enfermera: 150 años del desarrollo professional: el papel los colegios profesionales [tese]. Ferrol (ES): Universidade da Coruña; 2008.-22. Santiago MAM. Las fundaciones sanitárias laicas en España del siglo XX: la Escuela de Enfermeria de la Fundación Jiménez Diaz [tese]. Madrid (ES): Universidad Complutense de Madrid; 2012. Its creation resulted from the need for training and qualification of the hospital labor. It is important to say that, prior to its functioning, the activities for care for the sick and training of nurses had been, for centuries, the responsibility of a number of religious orders, such as the Hermanas de San Juan de Dios and the Hijas de la Caridad de San Vicente de Pául.22. Santiago MAM. Las fundaciones sanitárias laicas en España del siglo XX: la Escuela de Enfermeria de la Fundación Jiménez Diaz [tese]. Madrid (ES): Universidad Complutense de Madrid; 2012.

Its graduates, along with the practitioners and midwives, came to make up the body of professionals termed as health assistants, all educated to senior high school level. In spite of this initiative, training remained as before, that is, occurring separately. In relation to the Real Escuela de Enfermeras de Santa Isabel de Hungria, in spite of its importance for the professionalization of Spanish Nursing, it did not function for long, as its activities were terminated too early, in 1932.11. Domínguez SQ. Del practicante a la enfermera: 150 años del desarrollo professional: el papel los colegios profesionales [tese]. Ferrol (ES): Universidade da Coruña; 2008.-22. Santiago MAM. Las fundaciones sanitárias laicas en España del siglo XX: la Escuela de Enfermeria de la Fundación Jiménez Diaz [tese]. Madrid (ES): Universidad Complutense de Madrid; 2012.

Decades later, Joaquim Ruiz-Giménez, the then-Minister for Education (1951-1956), through the Royal Decree of 4th December 1953,3 published in the Boletim Oficial da Espanha (Official Bulletin of the State) (BOE) of 29th December 1953, unified the health assistants' studies. From that point onward, those wishing for this qualification were to receive the same training and, on concluding their studies, were to receive the title of Technical Health Assistant (ATS), although, in practice, there were many obstacles hindering compliance with this standardization.

In the 1970s, the intense national mobilizations and political articulations of the ATS and nurses culminated in the approval of Royal Decree 2128/1977,44. Ministerio de Educación y Ciencia (España). Real Decreto 2128, de 23 de julio de 1977, por el que se integran los estúdios de ATS en las Universidad como Escuelas Universitaria de Enfermeria hasta el momento existente em la Facultad de Medicina, creándose la titulación de Diplomado en Enfermeria. Boletín Oficial del Estado, 22 Ago 1977. BOE of 22nd of August 1977. This document stipulated that the nursing and ATS schools - maintained and financed by separate entities - were to be integrated with the universities as University Schools of Nursing, through meeting the new recommendations, and that those who graduated from their courses would be termed, from then on, as having Diplomas in Nursing.

This was of extreme importance for Spanish Nursing, and enabled it to take responsibility for managing its own professional training and the management of the schools, following the example of what was already happening in other countries guided by the precepts of Professional Nursing instituted by Florence Nightingale.55. Cadaya NM, Fernádez MLF. El rol enfermeiro: cambios mas significativos entre ayudante técnico santario y diplomado en enfermeria. Cultura de los Cuidados [internet]. 2012 [cited 2014 Dec 17]; 33(2º cuadrimestre):. Available from: http://rua.ua.es/dspace/handle/10045/24148
http://rua.ua.es/dspace/handle/10045/241...

At the beginning of the 1980s, Royal Decree 111/1980 and the Order of 15.07.1980, recognized and ensured the equality of professional, cooperative and normative rights and also established, with the participation of the Universidad Nacional de Educación a Distancia (UNED), the terms for academic validation within teaching and the title of ATS to Graduate in Nursing.66. Ministerio de Unidersidades y Investigación (España). Real Decreto 111, de 11 de enero de 1980, por el que se homologan los títulos de ATS y Diplomado en Enfermeria a efectos de derechos profesionales, corporativos y nominativos. Boletín Oficial del Estado, 23 Ene 1980.-77. Ministerio de Universidades y Investigación (España). Orden de 15 de julio de 1980, por la que se estabelece un curso de nivelación de conocimientos a efectos de convalidación académica del título de Ayudante Técnico Sanitario por el de Diplomado en Enfermeria. Boletín Oficial del Estado, 23 Jul 1980.

Finally, in order to understand this history better, it is important to say that Spanish Nursing has been negatively influenced by the various political and economic periods through which this country passed and continues to pass, sometimes presenting advances, and at others presenting setbacks. Between the period of the founding of the Real Escuela de Enfermeras de Santa Isabel de Hungria (1896) and the professional equalization and equalization of titles (1980), there occurred the Bourbon Restoration (1875-1931), the II Republic and Civil War (1931-1939), the dictatorship of General Franco (1939-1975), the Democratic Transition (1975-1978) and, since then, the Parliamentary Monarchy.

In the light of these brief considerations, the present manuscript aims to analyze the history of Nursing in Spain, in the period covered between 1953 and 1980. For this, it was essential to bring together the maximum of information, and investigate its origin and the relevant points in its evolution. This being the case, the study's undertaking is justified by the intention to contribute to the memory of the profession and of the teaching of Nursing in Spain, as well as to foster further studies.

METHOD

This is a historical-social study, of the documentary type, undertaken in the second semester of 2014, during the undertaking of the placement of a Sandwich Doctoral course Abroad, at the Facultad de Enfermeria, Fisoterapia y Podologia, of the Universidad de Sevilla, in Spain, as part of the Science without Borders Program, supported by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior.

As a research source, written and non-written documents (films, videos, slides, photographs, posters) must be valued and appreciated, given the variety of information which can be extracted from them and applied to the various areas of knowledge. It is, therefore, essential that they should be subjected to critical and contextualized analysis of the historical-social period in which they were created.88. Sá-Silva JR, Almeida CD, Guindani JF. Pesquisa Documental: pistas, teorias e metodologias. Rev Brase Hist Ciênc Sociais [internet]. 2009 [cited 2014 Dec 18]; 1(1):. Available from: http://rbhcs.com/index_arquivos/Artigo.Pesquisa%20documental.pdf
http://rbhcs.com/index_arquivos/Artigo.P...
In the light of this, the historical studies, which have as their design the study, analysis and understanding of past happenings, take on relevance as they favor the grasping of the facts, the societies, their contexts and their discourses, thus contributing to the (re-)writing of history.99. Maia AMR, Costa E, Padilha MI, Borenstein MS. Pesquisa Histórica: possibilidades teóricas, filosóficas e metodológicas para análise de fontes documentais. Rev Eletr Enf [internet]. 2011 [cited 2014 Dec 18]; 1(2):. Available from: http://www.abennacional.org.br/centrodememoria/here/n3vol1_reflexao.pdf
http://www.abennacional.org.br/centrodem...

The development of this work, therefore, which took place between the months of September and December 2014, was made possible based on consultations undertaken in the archive services of the Hemeroteca Municipal de Sevilla, of the Diputación de Sevilla Facultad de Enfermeria, Fisioterapia y Podologia, of the Universidad de Sevilla. For this, searches were undertaken in newspapers with national and local circulation, in the city of Seville, Spain. In addition to this, printed and digitalized documents were also researched (minutes, official correspondence, Laws and Decrees) and reporting referent to Spanish Nursing. Equally, specialized journals, books and academic works available in the Library of the Universidad de Sevilla, as well as publications made available in the Virtual Health Library, were used.

The historic time marker for this study began in the year of 1953, on the occasion of the unification of the teaching of the health assistants - practitioners, midwives and nurses - in ATS and finished at the time of the approval of the norms for validation of the title of ATS as Diploma in Nursing, in the year of 1980.

The stages of analysis and interpretation of the data occurred through close and detailed reading of all the material. Use was made, therefore, of thematic analysis, aiming for the thorough and systematic understanding of the meanings, for the (re-)construction of part of the history of Spanish Nursing. It was undertaken respecting the precepts of the guidelines of Resolution N. 466/12, of the Brazilian National Health Council.1010. Ministério da Saúde (BR). Conselho Nacional de Saúde, Comissão Nacional de Ética em Pesquisa. Resolução nº 466 de 12 de dezembro de 2012: aprova as diretrizes e normas regulamentadoras de pesquisa envolvendo seres humanos. Brasília (DF): Ministério da Saúde; 2012.

RESULTS

The study made it possible to observe some aspects relevant to Spanish Nursing in the period covered by 1953-1980, with emphasis on: the fusion of three health professions (practitioners, midwives and nurses); the publication of decrees and orders for the regulation of the teaching; the growth in the number of schools in the 1970s; and the intense political articulation and mobilization of this professional category employed as a strategy for its conquests.

Regarding the teaching of practitioners and midwives, it is relevant to inform that since 1861, these had been undertaken under medical jurisdiction, with a duration of two years, and that they consisted of a common axis with notions of anatomy, physiology, asepsis, antisepsis and the undertaking of practices. The career of practitioner, which was exclusively male, required a minimum age of 16 years completed, and when trained these people were responsible for the undertaking of procedures, such as: dressings, bandages, administration of medications, vaccination and minor surgery (removal of corns, bloodletting and dental extractions). Future midwives, genuinely female, were required to be aged over 20 years old and learned the notions of obstetrics in order to assist in natural births.11. Domínguez SQ. Del practicante a la enfermera: 150 años del desarrollo professional: el papel los colegios profesionales [tese]. Ferrol (ES): Universidade da Coruña; 2008.

In relation to the training of the nurses, using the Escuela de Santa Izabel de Hungria as a reference, the requirements were: to be able to read, write and do arithmetic, and to be aged between 23 and 40 years old. The students were to receive, over the two years of training, notions regarding body hygiene, infections and disinfection, asepsis and antisepsis and general care for the sick, and were to undertake hospital practices among other forms of care. It is important to state that, although they received the same training, the students were classified as external and internal, and were assured, for financial reasons, the right to boarding (housing and food) conditional on their duty to the hospital to which the school was attached, such as: the provision of services, attendance in the wards, night shifts, and domestic tasks.11. Domínguez SQ. Del practicante a la enfermera: 150 años del desarrollo professional: el papel los colegios profesionales [tese]. Ferrol (ES): Universidade da Coruña; 2008.

Regarding the legislation relevant to teaching, the decision was made to list the most significant which, probably, best represent and facilitate an understanding of the historical evolution of Spanish Nursing. A summary of decrees and orders was therefore elaborated, as may be observed in table 1.

Table 1
Summary of the legislation relevant to the teaching of Nursing in Spain (1953-1980). Seville, 2014

Regarding the creation of schools set up for the training of ATS and nurses, the empirical material made it possible to report these in chronological order and identify the cities in which they were founded. However, for practical reasons, this includes only those whose inaugurations were made public through newspapers and which occurred in the 1970s, and prior to the incorporation of the same into the universities, which happened in 1977, as shown in Table 2.

Table 2
Schools for (female) nurses and Techinal Health Assistant (1970-77). Seville, Spain, 2014

Regarding the flow of the ATS and Nursing Schools, in the 1970s, data published by the Instituto Nacional de Estadísticas de España made it possible to elaborate Table 3, for which were prioritized the numerical aspects of the schools, enrollees, those who concluded the courses, and lecturers.

Table 3
Flow of the Spanish schools of Techinal Health Assistant and nurses, in the 1970s. Seville, Spain, 2014

Finally, the process of political transition which began in Spain in the 1970s made it possible for the trade unions to be able to reorganize and exercise their fundamental role, that of considered guidance and defense of the respective categories' interests. In the case of Nursing, the work of the local and national Councils contributed to its conquests through mobilizing this professional category, undertaking assemblies, guidance of actions, the development of projects and through the discussions of the problems relevant to professional training and the exercising of the profession.

DISCUSSION

In the history of Spanish Nursing (1953-1980) regarding the legislation of the teaching of ATS and nurses (Table 1), it is possible to observe the existence of a gap in time of nearly two years between the unification of the studies of the practitioners, midwives and nurses in ATS and the publication of the standards for the new organization.1111. Ministerio de Educación Nacional (España). Orden de 04 de julio de 1953, por la cual se dictan normas para la nueva organización a los estúdios de Ayudantes Tecnicos Sanitarios. Boletín Oficial del Estado, 02 Ago 1955. Regarding the new directives, the following deserve to be emphasized: a course lasting three years; a minimum age of 17 years, providing proof of having finished senior high school; being in good physical condition; receiving references from two competent persons; approval in the selection examination; and mandatory residence in a hall of residence, only for the women.1111. Ministerio de Educación Nacional (España). Orden de 04 de julio de 1953, por la cual se dictan normas para la nueva organización a los estúdios de Ayudantes Tecnicos Sanitarios. Boletín Oficial del Estado, 02 Ago 1955.

From then on, the teaching institutions came to subject their students, in the first trimester of the first year of the course, to a selective internal process through observations of the physical, moral, intellectual and vocational conditions which would determine or not the continuation of their studies. The curriculum encompassed the disciplines of the Health Sciences, the Humanities and Hospital Practices, and emphasized the teaching of morals, religion, and physical education. For the women, there was the course of Teaching for the Home, and for the men, notions of legal medicine. However, the obtaining of the title of ATS was dependent on a final examination - theoretical and practical - to be presented to a panel of professors and the issuing of the certificate was the responsibility of the Ministry of National Education.1111. Ministerio de Educación Nacional (España). Orden de 04 de julio de 1953, por la cual se dictan normas para la nueva organización a los estúdios de Ayudantes Tecnicos Sanitarios. Boletín Oficial del Estado, 02 Ago 1955.

Regarding this context, one can say that it represents a mixture of advances and setbacks. Advances, through recognizing the need for better professional qualification through the institution of three years of basic training and the possibility of creating specialization courses. Setbacks in that it maintained teaching separated by sex, there being both schools for male and female ATS; and the valorization of biological differences, such as: the course of Teaching for the Home, for the women, and notions of legal medicine for the men.

Regarding the schools, those for the training of men were attached to the Faculties of Medicine and their teaching was based in theoretical and technical knowledge; while the schools for women had teaching which was predominantly practical, and were integrated into the hospitals. Regarding the latter, one can highlight the emphasis placed, in their teaching plans, on courses related to religious training and to domestic tasks.1212. González JS. Historia de la Enfermeria. Madrid (ES): DAE/Paradigmas; 2011.

The scenario reflects the female condition in the political-social context during the dictatorship of General Franco: submission to the male figure, being kept within the home, and valued for motherhood and virtues such as sweetness and selflessness, with the following falling to women: domestic occupations and teaching and nursing.1313. Santos TCF, Oliveira AB, Gomes MLB, Peres MAA, Almeida Filho AJ, Abrão FMS. Rituales patriocos y religiosos: contribuición a la identidad de las enfermeras brasilñas y españolas (1937-1945). Esc Anna Nery [internet]. 2013 [cited 2104 Dec 19]; 117(1):. Available from: http://www.scielo.br/pdf/ean/v17n1/15.pdf
http://www.scielo.br/pdf/ean/v17n1/15.pd...
This archetype of a well-behaved woman, initiated from childhood and adolescence, would favor the acceptance of the norms imposed during the training as a nurse.1414. Costa LHR, Coelho EAC. Ideologies of gender and sexuality: the interface between family upbringing and nursing education. Texto Contexto Enferm [internet]. 2013 [cited 2014 Dec 19]; 22(2):. Available from: http://www.scielo.br/pdf/tce/v22n2/v22n2a26.pdf
http://www.scielo.br/pdf/tce/v22n2/v22n2...

Gender prejudice is associated with the figure of the female and, when related to nurses, to whom is attributed a divine mission, with characteristics of priesthood, the provision of care is often mixed up with the provision of domestic tasks. This stereotype of the nurse and the woman caused their social places to remain very close and intrinsically related, as, in the work environment, they owed obedience to the doctors - and at home, to their husbands.1515. Coelho EAC. Gênero, saúde e enfermagem. Rev Bras Enferm [internet]. 2005 [cited 2014 Dec 20]; 58(3):. Available from: http://www.scielo.br/pdf/reben/v58n3/a18v58n3.pdf
http://www.scielo.br/pdf/reben/v58n3/a18...
The model of woman, holy and servile, accompanied the image of the nurse for a long time.16. Maliska ICA, Padilhe IM, Borenstein MS, Costa R, Gegrório VRP, Vieira MV. A enfermagem francesa: assistência e educação - considerações acerca de sua história e perspectivas atuais. Texto Contexto Enferm [internet]. 2010 [cited 2014 Dec 20]; 19(2):. Available from: http://www.scielo.br/pdf/tce/v19n2/14.pdf
http://www.scielo.br/pdf/tce/v19n2/14.pd...

In Spain, in this period, the situation may have gained greater proportions due to the major participation of nuns in the country's educational system, as in the teaching of Nursing. As a result of this, the women who wished to work in the careers of teaching or nursing, genuinely female professions, were also to dedicate themselves to religion and to prayers.1212. González JS. Historia de la Enfermeria. Madrid (ES): DAE/Paradigmas; 2011.

Illiteracy among women was double that found among men and crimes such as adultery were punished with up to six years' imprisonment for women.1717. La discriminación de la mujer española. El Socialista, 29 may 1977. p. 12-13. However, it is worth emphasizing a counterpoint which took place in Salamanca, in 1969, which although not directly related to nursing, does relate to the Spanish female condition. This occurrence, unprecedented at the time and emphasized in the press, may be seen as the beginning of women's conquests and the insertion of women in this predominantly male space. "Por la primera vez en la historia de la Universidad española, una mujer, decano de Facultad. Se trata de la doctora doña Gloria Begué Canton, catedrático de Hacienda y Economia de la Facultad de Direcho, que a medio dia há assumido el decanato de su Facultad, em una breve cerimonia celebrada en el Rectorado".18:49

Returning to the teaching of ATS, in relation to the setting up of the speciality courses (Table 1), it is highly probable that this occurred in order to meet the requirements of the use of new technologies applied to health, as the newspapers frequently published materials such as: "Diagnostico por computador";19:53 "Hoy se inaugurarán modernas instalaciones de cuidados intensivo";20:25 "Moderno medio de diagnostico radiológico en el hospital de San Pablo: es un Acta Scanner, uno de los primeiros en España".21:29

It is important also to say that this expansion of the teaching of ATS may be analyzed as the consequence of the Planes de Desarrollo used during the Francoist period, between the years of 1964 and 1975, to drive the country's economic and social growth, as well as as a result of the approval in 1962 of the Ley de Hospitales, through which the opening of new health services was promoted, coming to triple the number of hospitals in 1970 and, as a consequence, the number of professionals.1212. González JS. Historia de la Enfermeria. Madrid (ES): DAE/Paradigmas; 2011.

One can see, therefore, that these new requirements led to the requiring of qualified professionals and, related to the training of the ATS, in the period 1957-1977, ten specialization courses were set up (Table 1), among which Physiotherapy and Chiropody deserve to be emphasized as both, from 1980 onwards, acquired autonomy and came to be part of the Universities.2222. Ministerio de Universidades e Investigación (España). Real Decreto 2965/1980, de 12 de diciembre, sobre integración en la Universidad de los estúdios de Fisioterapia como Escuela Universitaria de Fisioterapia. Creación. Boletín Oficial del Estado, 19 Ene 1980.-2323. Ministerio de Universidades e Investigación (España). Real Decreto 2966/1980, de 12 de diciembre, sobre los estúdios de Podologia. Creación. Boletin Oficial del Estado, 19 Ene 1980.

Under this new condition, these courses began to benefit from the status of university schools, and their graduates, from the higher education diploma. In spite of this, in some university institutions, even today, these courses continue to be physically very close to Nursing, with the name of Facultad de Enfermeria, Fisioterapia y Podologia, as in the case of the Universidad de Sevilla.

In relation to the ATS schools (Table 2), the analysis of the empirical material made it possible to count the inauguration of 23 in 1970-1977, with the greatest flow being in 1976, with ten, and the lowest in 1977, with only one school. This scenario must be attributed to the incorporation of the schools of ATS and nurses into the universities, as well as to the creation of new schools, all under the new denomination of University School of Nursing and, as a consequence, the status as a university level profession. One can also see a heterogenous distribution of these schools, as of the 17 autonomous communities which make up the political map of Spain, only eight recorded inaugurations, with emphasis on Catalonia and Andalusia, with 11 and five new schools respectively. One can also observe that the newspaper La Vanguardia Española provided the greatest coverage to these events, reporting on 19 of them.

Regarding this new context, Table 3 allows a numerical understanding regarding the teaching of the ATS and nurses in the 1970s, in relation to the items of schools, enrollees, graduates and lecturers. In analyzing it, it is possible to visualize that the growing tendency presented in these items extended up to the year of 1977 and, that from then on it entered a decline. This observation reinforces the belief in the interest in nursing as a degree level profession, as well as arising from this condition.

The schools' incorporation into the universities consisted of their adaptation to the requirements made by the European Union regarding the recognition of diplomas, titles and certificates as a way of favoring the free provision of services in the continent.11. Domínguez SQ. Del practicante a la enfermera: 150 años del desarrollo professional: el papel los colegios profesionales [tese]. Ferrol (ES): Universidade da Coruña; 2008. At that time, in Spain, there was a shortage of nursing professionals, heterogeneity of training and of titles (practitioners, midwives, nurses and ATS).24 In addition to this, there were provisos regarding training separated by sex; absence of programs which reflected the needs of the nursing services geared towards educational actions and health promotion action; the exclusiveness of male nurses in the management and administration of the nursing services; and the inexistence of Postgraduate Programs.2525. Organización Mundial de la Salud. Documentos de la OMS: enfermeria española. Tribuna Medica. Madrid (ES): OMS; 1976; 665: 1-8.

This phase is seen as the mark of the professionalization of Nursing in Spain, as the schools' incorporation into the universities led to the nurses taking control of the teaching-learning process and the management of the nursing services. It was a period of intense activity for meeting the new requirements, the elaboration of teaching plans, and the composition and qualification of the teaching faculty; after all, it was necessary to classify a broad historical tradition, a secular practice, and many accumulated knowledges.22. Santiago MAM. Las fundaciones sanitárias laicas en España del siglo XX: la Escuela de Enfermeria de la Fundación Jiménez Diaz [tese]. Madrid (ES): Universidad Complutense de Madrid; 2012.

Analyzing this occurrence in the light of the precepts of Modern Nursing, instituted by Florence Nightingale, in which the nursing schools and organizations must be organized, guided and managed, obligatorily by nurses, one can conclude that the journey traveled by the profession in Spain was indeed a long one. In particular, regarding the teaching, although the Real Escuela de Enfermeras de Santa Isabel de Hungria (1896) is considered the country's first, in the anglo-saxon model, its functioning and management remained in the hands of the surgeon, Federico Rubio y Gali. This situation, which deserves more thorough investigation, gains relevance because of the absence, in accordance with the empirical material consulted, of records of nurses leading these schools prior to their incorporation into the universities.

Supporting this point, one newspaper published the following: "Según las próprias enfermeras de la Sección de Estudios del Colégio Provincial, la enseñanza no está dirigida por enfermeras sino por médicos. Actualmente um catedrático es diretor de la Escuela, cuando deberia ser una enfermera [referring to the School of Nursing of the Teaching Hospital, in Barcelona]".26:25

The schools which wished to be incorporated into the universities were to make requests to the Rectorates and, if approved, their integration would be the responsibility of a Management Commission made up of representatives from the Faculty of Medicine, the ATS Council and of the School (the principle, one professor and one student). Regarding the new schools, their regulation fell to the Ministry of Education and Science in accordance with the Directives of the General Law of Education then current. Regarding the schools' lecturers, these were assured the same administrative and economic conditions, as well as the continuity of their roles until the complete extinction of the teaching of ATS, or the creation of spaces for university teaching.44. Ministerio de Educación y Ciencia (España). Real Decreto 2128, de 23 de julio de 1977, por el que se integran los estúdios de ATS en las Universidad como Escuelas Universitaria de Enfermeria hasta el momento existente em la Facultad de Medicina, creándose la titulación de Diplomado en Enfermeria. Boletín Oficial del Estado, 22 Ago 1977.

It is appropriate to mention that, although Spanish Nursing had assumed that it would receive the support of the European Union and of bodies such as the World Health Organization and the International Labor Organization - which had long been concerned about the obstacles (issues of gender; the myth of dedication untainted by financial interest; inadequate pay; religious influence; and long working days)27 - their organization and mobilization was decisive to the conquering of the university career, as, in accordance with the excerpts from the publications below, the scenario was:

"Catorce mil seiscientas son las religiosas que prestan sus servicios en los centros hospitalários de España, hallandose en el 71 por 100 del total de los existentes y casi en el 100 por 100 de los dependientes de entidades públicas. Su labor es valiosíssima y cada vez más actualidad, dado el cambio acelerado que está experimentando el hospital". 28:46

"Havia un contrato entre los hospitales y una orden religiosa, en los que la superiora era automaticamente la jefe de enfermeras; las Hermanas eran jefes de servicios, y, si se contrataban además enfermeras laicas, esta eran encargadas de los trabajos de enfermeria básica. Además estaban los practicantes masculinos que dependian unicamente del medico - no del medico y de las hermanas como las enfermeras".29:29

"Los paros se han realizados, en un gran número de províncias españolas, asi como en las Escuelas de ATS - praticamente han parado todas [...] las reivindicaciones son: creación de escuelas universitárias [...] participación de los profesionales em todas sus ramas (practicantes, enfermeras, auxiliares de laboratório, de quirófano etc) en la redacción de los programas y planes de estúdios [...] uma sanidade deocratica y sin discriminaciones".30:11

"Numerosas enfermeras y ayudantes técnicos sanitários (ATS) de Barcelona se manisfestaron ayer ante la Universidad Central para exigir que sus estúdios sean elevados al grado de diplomados".31:15

"Habia, pues, hasta ahora, tres colégios: ATS masculino y practicantes, enfermeras y matronas y ATS especialista em Obstetricia y Ginecologia [...] con convocatoria para la constituición de un único colégio profesional".32:15

These excerpts from newspapers serve as a small sample of how agitated and decisive the 1970s were for Spanish Nursing; although it had counted on the support of international agencies, its professionals had decisive participation in the struggle for training which was worthy, qualified and responsible. This successful process required, therefore, from its leadership, effort, political clarity and skills such that the play of interests would not hinder that which, among others, became the greatest conquest, that of Nursing as a higher education course.

As a university course, Nursing came to have a duration of three years and began in the academic year of 1977-1978; the professionals who had already graduated and who were working in the area were assured the same corporative and nominative rights, as well as the right to validation of the title of ATS to nurse subsequent to sitting examinations.44. Ministerio de Educación y Ciencia (España). Real Decreto 2128, de 23 de julio de 1977, por el que se integran los estúdios de ATS en las Universidad como Escuelas Universitaria de Enfermeria hasta el momento existente em la Facultad de Medicina, creándose la titulación de Diplomado en Enfermeria. Boletín Oficial del Estado, 22 Ago 1977. It fell to the Ministry of Universities and Investigation to elaborate the standards for the Course of Equalization of Knowledge for Academic Validation of the Title of Sanitary Health Assistant with Diploma in Nursing, and to the Universidad Nacional de Educación a Distancia (UNED), the selection, over a five-year period, from 1st October 1980, in two annual invitations: January and June.66. Ministerio de Unidersidades y Investigación (España). Real Decreto 111, de 11 de enero de 1980, por el que se homologan los títulos de ATS y Diplomado en Enfermeria a efectos de derechos profesionales, corporativos y nominativos. Boletín Oficial del Estado, 23 Ene 1980.-77. Ministerio de Universidades y Investigación (España). Orden de 15 de julio de 1980, por la que se estabelece un curso de nivelación de conocimientos a efectos de convalidación académica del título de Ayudante Técnico Sanitario por el de Diplomado en Enfermeria. Boletín Oficial del Estado, 23 Jul 1980.

This being the case, one can perceive through these introductory notes regarding the history of Spanish Nursing (1953-1980) that all the transformations, mobilizations and struggles through which it passed were not in vain; that is, they contributed to the creation of a separate identity, and also represent its empowerment in relation to its own organization.

FINAL CONSIDERATIONS

In concluding this study, it is important to reassert that its objective was to analyze the history of Spanish Nursing, in the period covered by 1953 to 1980, and that its purpose was to contribute to the memory of the profession and of the teaching, and to encourage further investigations, hence the intention of presenting it as introductory notes. The reconstruction of the facts and the record of this trajectory were possible based on the consulting of the archive services of Seville, Spain, as well as newspapers, academic productions, legislation, and specialized publications, among others.

In relation to the teaching of Nursing, studies have considered the Real Escuela de Enfermeras de Santa Isabel de Hungria as the pioneer in the anglo-saxon model. Regarding the same, it is worth making the caveat that its functioning and management were not exclusively undertaken by female nurses, as the precepts of Modern Nursing, conceptualized by Florence Nightingale, advise. For that format, the schools of female nurses and ATS had to wait until 1977, when they were unified and incorporated into the universities.

It is important to say that Spanish Nursing, as presented today, is the result of the joining of three professions - practitioners, midwives and nurses - and that, in its trajectory, many were the obstacles to be overcome, such as: a totalitarian political regime; the unification of the teachings; professional training divided by sex; Nursing services under the command of religious orders; a shortage of schools; professional qualification and training in accordance with the requirements of the market through the use of new health technologies; and the democratic transition; among others.

Finally, it is worth emphasizing that the present manuscript has brought as a contribution the analysis of part of the history of Nursing (1953-1980), its struggles and conquests, but that on its own is not exhaustive. It is therefore suggested that further investigations be undertaken raising issues relevant to the teaching and history of Nursing in Spain and, thus, to extending knowledge regarding the profession.

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Publication Dates

  • Publication in this collection
    2016

History

  • Received
    25 Mar 2015
  • Accepted
    11 Sept 2015
Universidade Federal de Santa Catarina, Programa de Pós Graduação em Enfermagem Campus Universitário Trindade, 88040-970 Florianópolis - Santa Catarina - Brasil, Tel.: (55 48) 3721-4915 / (55 48) 3721-9043 - Florianópolis - SC - Brazil
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