Development of nursing in Russia. History of nursing in Russia History of the creation and development of nursing

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STATE BUDGETARY PROFESSIONAL EDUCATIONAL INSTITUTION

STAVROPOL REGION

"BUDENNOVSKY MEDICAL COLLEGE"

METHODOLOGICAL DEVELOPMENT

SCIENTIFIC AND PRACTICAL CONFERENCE ON THE TOPIC: HISTORY OF NURSING DEVELOPMENT

Teachers

Professional module:

Parasich N.N.

Budagova V.V.

Budennovsk, 2016

PLAN

Introduction

History of nursing.

Florence Nightingen – a heart given to people. (video film)

The history of the nurse's costume.

Emergence of concepts:

Ethics

Deontology

Nurses' problems

Summarizing.

Goals:

Educational:

Formation of professional competencies 1-12.

Further formation and systematization of knowledge.

Educational:

Formation of general competencies 1-13.

Developing in students important personal and professional qualities of a medical worker:

Ability to recognize responsibility for the patient’s life;

Ability to analyze your behavior;

Formation of a sense of responsibility for timely and high-quality nursing care.

Educational:

Formation in students: skills of analysis and synthesis of the material being studied.

About the history of the development of nursing in Russia

The most complete analysis of the history of the development of nursing in Russia presented in the works of G.M. Perfileva

and in the monograph “History of Nursing in Russia”. G.M. Perfilyeva believes that the formation of secular nursing took an original path, without the noticeable influence of European medicine. It is Russia that has priority in shaping the idea of ​​nursing care as a special form of medical activity that requires special theoretical training. As an example, she refers to the textbook of the Russian surgeon, chief physician of the Mariinsky Hospital for the Poor, Christopher von Oppel (1822). Almost half a century later, many of his ideas were reflected in the works of F. Nightingale. But international isolation deprived both Russian sisters of the opportunity to join international experience and foreign colleagues to get acquainted with our achievements.
Summarizing the history of the development of nursing in Russia in the 16th-20th centuries, we tried to trace its main milestones (Table 1-1). For analysis, we will conditionally highlight four stages of the development of nursing in Russia: pre-Petrine; 1701-1917; 1918-1976; from 1977 to the present day.

Pre-Petrine period of development of nursing

In Rus', court doctors appeared already in the 10th century. under the Kyiv princes. These were mainly monks of the Kiev-Pechersk Monastery. Hospital wards were created at the monasteries. The place where pain puts a person “prone” began to be called hospitals. One of the first mentions of a hospital hospital in Rus' is associated with the name of Princess Olga, who organized a hospital where women began to care for the sick. The monasteries taught the art of healing and medical culture to the daughters and widows of noble people. Hospital buildings, as a rule, were located outside the monastery walls, with laundries, baths, vegetable gardens, and cemeteries adjacent to them. The rich were obliged to take care of the comfortable existence of hospitals. During the days spent undergoing treatment in the hospital, the poor worked on arable land, in the fields, and as a carriage driver.

Table. Main milestones in the development of nursing in Russia in the 16th-20th centuries .

Before the Tatar invasion, the chronicles mention hospitals in Kyiv, Pereyaslavl South, Smolensk, Vyshgorod, Chernigov, Novgorod, Pskov, Volyn, Galician Rus, etc.
Characterizing the state of health care during the period of the Mongol-Tatar yoke, Russian medical historian N.P. Zagoskin wrote: “Laid out in the XII-XIII centuries. The beginnings of secular medicine are stalled in this era, ... medicine is completely withdrawn into monasteries...” But the rich traditions of traditional medicine were not lost, and handwritten works continued to spread. They gave advice on the use of medicinal herbs, food hygiene, and the use of baths. From the chronicle we know about Eupraxia, born in 1108, the granddaughter of Prince Vladimir,

who deeply studied traditional medicine and left the first domestic medical work called “Ointments.” It is devoted to issues of physiology, hygiene, propaedeutics, and the prevention of certain diseases.
In 1551, at the Stoglavy Cathedral, the intention to open state hospitals and almshouses was first expressed, since monastery almshouses cannot “look after and treat everyone.” But, as we will see below, the first state hospital was opened in Moscow in 1707.
Thus, in Muscovite Rus', the participation of women in the fate of the sick was manifested in various types of charitable activities carried out by representatives of various classes.

Development of nursing in 1701-1917.

Development of nursing in the 18th century. For the first time, women began to be involved in caring for the sick under Peter I (1682-1725). For example, they had to serve in educational homes created “... for the preservation of shameful babies, whom wives and girls give birth to unlawfully.” However, the issue of “charity for foundlings” was resolved only under Catherine II, who opened educational homes in Moscow and St. Petersburg in the 60s of the 18th century.
In addition to the Military Regulations of 1716, Peter I defined the responsibilities of women in caring for the sick by the “Regulations on the Administration of the Admiralty and Shipyards”. In 1728, after the death of Peter I, staff positions for women were introduced into the hospital schedule.
In the “General Regulations on Hospitals” (1735) it is written: “Women should be employed in hospitals to wash the dresses and all linen of sick people. To supervise linen and female workers, have
each hospital has one matron and one assistant from old widows or good married wives who bear the praise of good fortune, and in this paragraph keep the mentioned workers in strong charity, so that not a single one of them could have similarities and talk with young single doctors and students, also with the sick or with the guard soldiers or with the guards, and be very careful that, besides those mentioned, other women (of whatever rank) do not enter the hospital.”
But the lack of a system for organizing women’s labor in hospitals and the lack of command interest in it led to the fact that in most hospitals, the participation of women in care either ceased over time or was temporary. As a result, the sick and wounded, especially in wartime, were practically completely self-sufficient. For example, in 1808, in the Grodno hospital there were 500 patients per doctor, with a complete absence of medical personnel.
As noted above, the initiatives of Peter I were destined to come true only during the reign of Catherine II (1762-1796). In 1763, the Pavlovsk Hospital was established in Moscow, in which the staff was supposed to have nursing soldiers, and for women - nursing women from the wives and widows of hospital soldiers. One of them was appointed “to examine sick women in hidden places of illness and insert enemas into them” and was called a babka, or clerister.
Later, women's labor began to be used in medical institutions of the military department. In the reports of the auditors appointed by the medical board for inspection for 1785, it was noted: “For cooking, for washing clothes and keeping the beds clean, there are a sufficient number of female soldiers at the hospital, and they are paid decently. These women are used to serve the sick, for whom, due to the types of illnesses, their care is decent.”
Based on the foregoing, we can conclude that in the 17th century. care in hospitals was provided by men (retired soldiers), “side-soldiers.” In the 18th century As part of the reforms carried out by Peter I, women began to be involved in caring for the sick in civilian and military medical institutions. At first these were old women from monasteries, then wives and widows of hospital soldiers. At that time, apparently, there was no special training for nurses to care for the sick.
Service of “compassionate widows”. Some authors believe that nursing in Russia arose in 1803, when the service of “compassionate widows” appeared. This year, Empress Maria Feodorovna is establishing “widows’ houses” in Moscow and St. Petersburg - shelters for poor widows left without a livelihood. The wonderful Russian writer A.I. spent his childhood in one of these houses. Kuprina. He described his childhood memories of the common ward of the “widow’s house” in the story “Holy Lies.”
In 1813, it was decided to recruit a number of widows from the St. Petersburg widow's home to assist in raising orphans and to work as nurses in the Mariinsky Hospital for the poor.
Mariinsky Hospital in St. Petersburg is the first private charitable medical institution. The hospital has 200 beds and an outpatient clinic, 9 doctors, 12 paramedics, 14 matrons, 60 attendants, and 54 other servants.
The hospital was completely self-sufficient. The income from the greenhouse, where vegetables and fruits were grown all year round, was enough to pay the salaries of all the staff, food for the sick and medicines.
Clean and warm wards, clean and dry bed and underwear, good nutrition, regular ventilation of the premises, annual whitewashing and painting of each ward and corridors, full care and treatment provided the Mariinsky Hospital with a reputation as one of the best hospitals in Europe at that time.
The Empress developed rules and instructions for staff (including doctors), almost daily personally supervised the treatment process, the work of the staff and the board of trustees, and ensured that patients were supplied with money, medicine and clothing after discharge.
At the beginning of 1814, 24 widows who expressed a desire to devote themselves to caring for the sick began their duties: every two weeks, eight widows moved to the hospital for duty. They observed the condition of the wards, the order in the distribution of food and medicine, the cleanliness and tidiness of the patients, their beds and linen, the behavior of patients and visitors. At the same time, women mastered some medical techniques in order to be able to provide assistance if necessary.
In March 1815, for the first time, 16 “compassionate widows” who had completed their probationary period were sworn in and presented with an insignia - the Golden Cross, which was ordered to be worn on
neck all my life, even if the “compassionate widow” retired. From the second year of service, “widows” could visit the sick in private homes, receiving payment for this. In 1819, a special verdict followed, establishing the Institute of Compassionate Widows. The ceremony of initiation and oath was carefully thought out by the empress herself. After completing the ritual, the dedicated widows received a certificate for the title of “compassionate”, which was published in the press.
With the establishment of the Institute of Compassionate Widows, the training of female medical personnel began. In terms of medical qualifications, compassionate widows occupied a middle position between a nurse and a nanny. Since 1850, widows' duty extended to the children's hospital. The existence of the service for compassionate widows was determined by the income of widows' homes and large donations from benefactors.
In 1818, a state service of nurses was created in Russia, who were trained in hospitals in sanitary and hygienic care for the sick and had full-time positions at hospitals. But in the first half of the 19th century. This form of training for medical personnel has not received proper development and has not made a significant contribution to patient care.
Thus, until the middle of the 19th century. The service of “compassionate widows” remained the only form of professional participation of women in caring for the sick. Christopher von Oppel, the chief physician of the Mariinsky Hospital in Moscow, in which compassionate widows from the Moscow widow's home served, published a textbook in 1822, which was called: “Guidelines and rules on how to care for the sick, for the benefit of everyone involved in this matter.” , and especially for compassionate widows who have especially dedicated themselves to this title.” The manual describes the principles of selecting nursing staff, the requirements for their physical and moral qualities, and the features of caring for the seriously ill, convalescent, wounded, infants, and the dying. Much attention is paid to the hygienic conditions of keeping patients, methods of performing manipulations, and rules for taking medications. The book is written clearly, thoughtfully, with great love and understanding of the importance of the work begun. It has not lost its relevance even today.
This textbook was used to train female medical personnel by doctors. This method of transmitting knowledge in our country has been preserved to this day, which, in our opinion, has its positive aspects (high intelligence of doctors, good theoretical and
practical training, knowledge of the peculiarities of a nurse’s work, her professional mistakes) and negative (the attitude of doctors towards the nurse with a certain shade of superiority, a view of the nurse’s problems only in the light of her role as an assistant).
“Compassionate widows” together with the sisters of mercy participated in the Crimean campaign of 1854-1856. Despite their noble origin (many were hereditary noblewomen), women performed the most difficult but necessary work. After the October Revolution, widows' houses were abolished, and their buildings were transferred to the People's Commissariat of Health. Since 1936, the building of the Moscow widow's house was occupied by the Central Order of Lenin Institute for Advanced Medical Studies (TSOLIUV), the administrative services of which are located there to this day (now the Russian Medical Academy of Postgraduate Education (RMAPO)).
Communities of Sisters of Charity. A qualitatively new stage in the development of nursing in Russia is associated with the organization of communities of sisters of mercy. On the initiative of Grand Duchess Alexandra Nikolaevna and Princess Theresa of Oldenburg, the first community of sisters of mercy in Russia was created in St. Petersburg (1844). The community received its name - Holy Trinity - only in 1873. The first community of sisters of mercy in Russia was based on the idea that caring for the sick and other forms of mercy could be a matter of personal achievement.
Initially, the community included seven departments: a department of sisters of mercy, a women's hospital, an almshouse for the incurable, a boarding house, a shelter for visiting children, a reformatory children's school, a department of penitents, or Magdalenes. Over time, most branches were closed. The community's activities were aimed exclusively at serving the poor and training sisters of mercy. During the opening years of the community, it consisted of 18 sisters of mercy and test subjects.
Widows and girls from 20 to 40 years old were accepted as sisters of mercy. Over the course of a year, the subjects underwent a training course and actually tested their mental and physical qualities necessary for this difficult work. The training of nurses was carried out by doctors serving in the community. Nurses were taught the rules of patient care, wound dressing techniques, pharmacy and recipes. Trained nurses performed duties that were otherwise assigned to medical assistants and paramedics. They received the sick, visited the community, and were on duty in the community hospital and private homes. Over time, they began to be invited to private and public hospitals and hospitals. Many famous doctors were invited to the community for consultations. From 1845 to 1856, the community was visited by N.I. Pirogov.
The community's activities quickly gained recognition. There was no shortage of people willing to take part in the work. However, living conditions in the communities differed sharply from those of the “compassionate widows.” Fulfillment of difficult and complex duties, ascetic life, discipline, lack of salary, pension, days off and vacations led to many sisters leaving the community. Only a quarter of the sisters stayed in the community for more than 10 years. Nevertheless, their work was more significant in terms of the volume and quality of medical care for the population than the activities of “compassionate widows.”
Since the demand for the activities of the sisters of mercy far exceeded the capacity of one community, there was a need to create new communities.
At the end of 1844 in St. Petersburg, Princess M.F. Baryatinskaya founded a community to help the needy and suffering, which a little later received a charter and the name “Community in the name of Christ the Savior.” From 1853 to 1875, 23 sisters of the community provided assistance to 103,785 patients.
In Moscow by the middle of the 19th century. There were few similar establishments. A community similar to Holy Trinity arose in Moscow in 1848 during a cholera epidemic. It was organized by two outstanding people: Princess Sofya Stepanovna Shcherbatova and Doctor Fyodor Petrovich Gaaz. This community received the name Nikolskaya. The sisters of this community took part in caring for the wounded during the Crimean campaign.
In 1850, the Sturdzovskaya almshouse for compassionate sisters was established in Odessa, which consisted of a community of sisters and a hospital in which they were trained. Only female patients received medical care in this hospital. At the hospital there was a senior doctor and several doctors and assistant doctors.
To participate in the Crimean War (1853-1856), the Holy Cross community of sisters of mercy was created.
The movement of the sisters of mercy after the Crimean campaign received a wide response in the hearts of the Russian people. One after another, new communities of sisters of mercy are opening in different cities of Russia: Moscow, St. Petersburg, Kharkov, Tiflis, etc.
Those wishing to enter the community previously underwent a probationary period of up to two years. In peacetime, the sisters looked after
patients in military hospitals and civilian hospitals, in the apartments of private individuals. In wartime, they were seconded by the community council to the Russian Red Cross Society and distributed among hospitals.
By becoming members of the community, the sisters took on hard work and high moral responsibility. This was a special form of asceticism, which only the strong in spirit could endure. They received no pensions, had no days off, no vacations. The communities were a kind of communes. They operated orphanages and schools, hospitals and outpatient clinics, craft and art workshops, and permanent nursing courses.
The charters of the communities differed little from each other. Their constant conditions were chastity and severity of behavior, love and mercy for one's neighbor, hard work and dedication, discipline and unquestioning submission to superiors. The statutes were strict, but retained some freedoms for community members (unlike monastic ones). The sisters had the right to own inheritance and their own property; if they wished, they could return to their parents who required care, or marry. Among the sisters of mercy there were many women and girls of noble origin. For example, Princess Shakhovskaya began her social activities as a nurse in the Moscow prison hospital. However, the charter did not allow anyone to make discounts, and no one sought privileges.
At the beginning of the 20th century. The management of charitable institutions was headed by Grand Duchess Elizaveta Feodorovna. In 1905, her husband, Grand Duke Sergei Alexandrovich, governor of Moscow, was killed. After this, the princess devoted herself entirely to charity. In 1907, Elizaveta Fedorovna established a community of sisters of mercy - the Martha and Mary Convent, named after two evangelical sisters, in whose fate two ideas were embodied: spiritual service and active charity. The community included a hospital, an outpatient clinic, a pharmacy, a shelter for orphan girls, and a Sunday school. There was also a canteen for the poor, a dormitory for the Sisters of Charity and the dormitories of an orphanage. The community ensemble was conceived by the princess herself. She had a subtle artistic taste and drew well. A beautiful park with greenhouses was laid out on the territory of the community. The monastery hospital was considered exemplary at that time. The best specialists worked there
Moscow. At the outpatient clinic, medical care was provided free of charge, and medications were provided free of charge at the pharmacy. The community helped with finding a job, home care, looked after children, and provided material assistance in the form of distributing money, clothing, and food. The Sisters of Charity, together with the Grand Duchess, visited slums and prisons. Elizaveta Fedorovna treated her duties very selflessly, cared for hopeless patients, took care of the sisters of the community, walked around the wards at night, and assisted during operations. She was very strict with herself, led an ascetic life: she slept no more than 3 hours on a wooden bed without a mattress, and was very abstinent in food.
In 1914, the monastery was converted into a hospital, the wounded were admitted here, and the Empress and her daughters worked here as sisters of mercy. The activities of the monastery continued after the revolution of 1917, until the arrest of the royal family. Elizaveta Fedorovna died tragically in 1918 in Alapaevsk along with other members of the royal family. At the end of the 20th century. Elizaveta Fedorovna and her cell attendant Varvara were canonized by the Russian Orthodox Church. Currently, the Grand Duchess has many admirers not only in our country, but also abroad. The Marfo-Mariinskaya Convent works, preserving the memory of its founder. In Moscow, on Bolshaya Ordynka, a monument to a woman was unveiled, whose dedication for the good of the Fatherland, in the name of love and compassion for people, can serve as an example to follow. In August 2004, the relics of the sister of mercy, Saint Elizabeth, visited Moscow, and admirers of this most illustrious woman could venerate them.
The existence of communities of mercy was a remarkable example of asceticism, which was picked up by Russian society in the second half of the 19th century. Women have proven that they deserve to have equal rights with men in the public life of the country.
The movement of the Sisters of Charity quickly gained strength and received universal recognition. By the end of 1912, 3,442 nurses worked in 109 charitable communities, and by the beginning of the First World War their number reached almost 20,000.
During the Crimean War (1853-1856), the shortage of medical personnel was especially acute. This war claimed the lives of almost 785,000 people. At the same time, the loss in killed was 53,000, and the rest died from wounds and disease. At the height of hostilities N.I. Pirogov was invited to Grand Duchess Elena Pavlovna, who in 1828 took over the leadership of charitable institutions. She introduced him to her plan - to create a women's organization to help the sick and wounded on the battlefield and invited N.I. Pirogov to take over the organization.
In 1854, the Exaltation of the Cross community of sisters of mercy was created in St. Petersburg, specifically for work in the army. The community charter was drawn up by N.I. himself. Pirogov. And he also led the activities of the community. The new initiative was met with skepticism in high circles. Concerns were expressed that sending a woman to the front could lead to moral decay in the army. However, women, with their selfless work and impeccable behavior, earned the respect and gratitude of not only soldiers, but also the entire people, writing a glorious page in the history of the development of nursing and domestic healthcare in general.
N.I. Pirogov highly appreciated the hard work, dedication and great moral influence that the sisters of mercy had on the soldiers. He wrote that the behavior of the sisters with doctors and their assistants was exemplary and worthy of respect, their treatment of the suffering was the most sincere, and in general all the actions of the sisters when caring for the sick, in comparison with the behavior of the hospital administration, should be called nothing less than noble.
During the Crimean War, Russian women for the first time left the sphere of domestic life in the field of public service, showing high business and moral qualities. The sisters acquired one of the specialties: surgical nurses (dressing nurses), pharmacists and housewives. Dressing nurses helped doctors during operations and dressings, and prepared dressings. Sister-housewives supervised the care of the sick, the cleanliness of linen and beds. Nurse pharmacists had to monitor the correct distribution of medicines and checked the work of paramedics.
“Compassionate widows” worked together with the sisters of the Holy Cross and St. Nicholas communities in Crimea. The best evidence of the selfless work of women is the fact that 12 widows died. Of the 60 sisters of mercy, almost all fell ill with typhus, 11 of them died.
The events of those years were preserved in the reports of the great surgeon, his memoirs and diary entries. They are most fully reflected in the “Sevastopol Letters”, which were documents of political content and had a significant influence on public opinion in Russia. Memories left us with the names of these great women, including noblewomen E. Bakunina, E. Khitrovo, A. Travina, M. Grigorieva and others.
Ekaterina Mikhailovna Bakunina (1812-1894) was distinguished by her unusually high moral and strong-willed qualities and precise performance of her duties as a nurse. N.I. Pirogov called her a tireless sister and considered her his faithful assistant. “Every day, day and night,” he recalls, “one could find her in the operating room, present at the operation, at a time when bombs and missiles either flew over or did not reach and lay around, ... she discovered with her accomplices a presence of mind barely compatible with female nature.”
Ekaterina Mikhailovna was raised in the spirit of the best family and national traditions, on the wonderful images of Russian classical literature. Her pedigree is the interweaving of two famous families in Russia: the Bakunins and the Golenishchev-Kutuzovs. Ekaterina Mikhailovna’s grandfather Ivan Loginovich had a friendship with Mikhail Illarionovich Kutuzov for many years, and they were married to sisters, so Ekaterina Mikhailovna can be considered the grandniece of the great commander.
In her declining years, Ekaterina Bakunina wrote “Memoirs of a Sister of Mercy,” the only one of its kind in the entire vast literature about the Crimean War, not counting “The Historical Mode of Action of the Holy Cross Community...” by N.I. himself. Pirogov.
In the first post-war years E.M. Bakunina, on the recommendation of Pirogov, led the Holy Cross community. But in the summer of 1860, she voluntarily resigned as sister abbess and parted with the community forever. The reason for such a serious step was disagreements with Elena Pavlovna on issues of further development and activities of the community. Further life of E.M. Bakunina confirmed the spiritual richness of her nature: until the end of her days, she tirelessly struggled with human misfortune - she treated peasants in the village of Kozitsino, Novotorsky district, Tver province, where she lived with her sisters. Participation in the Russian-Turkish War is one of the brightest pages of her interesting, but not yet written biography.
In the memoirs of N.I. Pirogov, doctors, and contemporaries, information about Daria Lavrentievna Mikhailova (real name Dasha Sevastopolskaya) has been preserved. She was one of those wives, sisters, daughters of Sevastopol residents who, even before the appearance of sisters of mercy and “compassionate widows,” provided assistance to the wounded. One of his contemporaries wrote that Dasha, who was left an orphan, first earned money by washing clothes and, together with the laundresses, followed the troops with her cart. Fortunately, in her cart there was both vinegar and some rags, which she used to bandage her wounds. Thus, Daria Mikhailova became the first sister of mercy on the battlefield.
Nicholas I learned about the girl’s feat from letters from his sons, who were in Crimea to “raise the spirit” of the Russian army, and took direct part in the girl’s fate. Daria was awarded a gold medal on the Vladimir ribbon with the inscription “For zeal” and 500 rubles in silver. She lived a long, modest life without reminding of herself. Unfortunately, neither the date of her death nor the place of burial have been established.
On the occasion of the 150th anniversary of the birth of Dasha of Sevastopol, on the initiative of the command of the medical service of the Red Banner Black Sea Fleet, the Red Banner Naval Hospital named after N.I. Pirogov and the Council of the Museum of the Fleet Medical Service approved a medal named after her. It was manufactured at the Sergo Ordzhonikidze Marine Plant production association. Every year the hospital hosts a competition for the title of best nurse. Those who occupy the highest step of the podium are awarded a medal named after Dasha of Sevastopol and are included on the Honor Board.
Efforts of N.I. Pirogov and the sisters themselves were not in vain. In his memoirs, he wrote that the results of the sisters’ participation in the war and the first experience of creating communities proves that until now the wonderful talents of our women have been completely ignored. He was worried about the future of the community, its internal life. “Our sister,” wrote Pirogov, “must be a woman with a practical mind and a good technical education, and at the same time she must certainly maintain the sensitivity of her heart, and such activity in women must be constantly supported. The nurses themselves must be independent of the administration, and the most educated must morally influence all hospital staff.” He believed that the activities of the sisters of mercy, despite all the difficulties, had a great future. He sums up the activities of the Holy Cross community this way: “...I hope that this young institution will be introduced in our other military hospitals forever. Every right-thinking doctor who wants his orders not to be carried out by the rough hand of a paramedic must sincerely wish for the prosperity of compassionate care for the sick.”
At the end of the war, 68 sisters were nominated for the medal “For the Defense of Sevastopol”. Of the 120 sisters of mercy of the Holy Cross community sent to Crimea, 17 died in the line of duty. Their memory is sacred to us.
Participation in the Russian-Turkish War (1877-1878). The heroine of the Russian-Turkish war was the sister of mercy Yulia Vrevskaya. Baroness, the daughter of a general, she considered “self-sacrifice for the good of others” her duty. V.A. Sologub wrote: “I have never met such a captivating woman in my entire life. Captivating not only for her appearance, but also for her femininity, grace, endless friendliness and endless kindness. This woman never said anything bad about anyone and did not allow anyone to slander anyone, but, on the contrary, she always tried to bring out the good sides in everyone.” From the very beginning of the war, Yulia goes to the front: “For 400 people, there are 5 of us sisters, the wounds are all very serious. I'm in the hospital all day." Yulia Vrevskaya refused her allotted leave and died of typhus in a military hospital in the Bulgarian city of Byala on January 24, 1878. In memory of Yu.P. Vrevskoy dedicated his prose poem to I.S. Turgenev.
Russian Red Cross Society. The founding meeting of the Society for the Care of Wounded and Sick Soldiers took place in St. Petersburg on May 18, 1867. Renamed the Russian Red Cross Society (ROSC) in 1879, it became a wealthy and influential organization carrying out missions to help the wounded in war and those affected by natural disasters. disasters both within the country and abroad.
In 1879, the competence of the ROKK included: organizing the training of sisters of mercy and monitoring the establishment and activities of communities of mercy. Most communities joined the ROKK, including the famous Holy Cross in St. Petersburg. By January 1, 1894, the ROCC had 49 mercy communities at its disposal. In 1903, the network of ROKK institutions with headquarters in St. Petersburg consisted of departments, committees, communities of sisters, hospitals, outpatient clinics, nursing homes, and orphanages.
In 1897, the Russian Red Cross Society established the Institute of Brothers of Charity in St. Petersburg, the purpose of which was to train male personnel to care for the sick and wounded and provide assistance in accidents. The training lasted 2 years. Except
communities of the Red Cross, training of sisters was also carried out at hospitals and monasteries.
The number of women who aspired to become sisters was constantly growing. Nursing training courses were organized in many large cities for all those wishing to join the profession. For future nurses, lectures were given and practical classes were conducted under the guidance of surgeons and special curators, in accordance with the standards and programs developed by the leaders of the RCCS.
The sisters' work was very highly paid, and their status was equal to that of a captain or major in the Russian army. In addition to the monthly allowance, which was higher than that of officers, women received additional funds for travel and sewing several sets of uniforms. In addition, the ROKK guaranteed pensions after 25 years of service and payment of benefits in case of illness acquired during the performance of official duties.

Development of nursing in 1918-1977.

The main events of this period of nursing development are presented in the table;
Analyzing the main milestones in the development of nursing in the post-October period, it should be said that the reforms began with the approval in 1919 by the People's Commissar of Health of the training plan and programs for schools of sisters of mercy, which provided for a purely practical method of teaching and, therefore, the constant stay of students in the hospital.
The young country needed new sisters who could be trained by schools that were fundamentally different from the schools of mercy. Thus, in 1920, the word “mercy” disappeared from medical usage. Communities of sisters of mercy are liquidated, the first state medical schools appear. In the new programs of the 1924 edition, it was noted that “the nurse must not only be a mechanical executor of the doctor’s prescription, but must be clearly aware of the significance of the specified method of treatment”; in the 1926 programs - that “the average health worker should only be an assistant to the doctor, working according to his instructions and under his supervision.” And only in 1929 was the issue of improving the qualifications of nursing staff resolved (at least once every 5 years).

Table. Main milestones in the development of nursing in Russia in 1919-1977.

After the nurse's specialty was reinstated (circa 1932), new training requirements specified that she perform nursing care under the direction of a physician or physician's assistant, and that she must be medically literate in order to be conscientious about the physician's orders.
In 1934, mass training of adults began under the GSO program (Ready for the sanitary defense of the USSR), as well as training for schoolchildren under the BGSO program (Be ready for the sanitary defense of the USSR). These programs included issues of first aid for wounds, injuries, issues of hygiene, sanitary care, and infectious diseases. At the same time, sanitary squads and posts were formed.
In 1936, a unified system for training paramedical personnel was introduced. Since 1939, the training of nurses began in each republic. Already in 1940, there were 967 medical and sanitary schools and departments in the former USSR.
During the Great Patriotic War, for the first time in the world in the Soviet army, a woman was brought to the line of fire - a sanitary instructor, whose duties included carrying out the wounded and providing them with emergency care. On August 23, 1941, an order was issued “On the procedure for providing medical instructors and porters with government awards.” For removing 15 wounded from the battlefield with their rifles and light machine guns, the medical instructor was presented with a government award - the medal “For Military Merit” or “For Courage”; for the removal of 25 wounded - the Order of the Red Star; for the removal of 40 wounded with their rifles and light machine guns - to the Order of the Red Banner; for the removal of 80 wounded with their rifles and light machine guns - to the Order of Lenin. In the German army, only men were used as orderlies and medical instructors. For 7 wounded carried out (without personal weapons) the Iron Cross was awarded.
Yulia Drunina, a famous poet and public figure, a former battalion medical instructor, holder of the military orders of the Patriotic War, 1st degree, and the Red Star, writes: “I do not come from childhood, from war... How many times has it happened to me - I need to take a wounded man out from under fire , but not enough strength. I want to unclench the fighter’s fingers to free the rifle - after all, it will be easier to drag. But the fighter grabbed her with a death grip. Almost without memory, but my hands remember the first soldier’s commandment - never, under any circumstances, throw away your weapon.”
The mortality rate among company instructors was the highest, sometimes only 30% of the personnel emerged from battles. “Not a single wounded person should remain on the battlefield” - this requirement in the difficult year of 1941 was not only a call. The everyday life of war knows many cases when the rescue of one wounded man cost the lives of two or three orderlies, although their actions were often covered by the fire of an entire unit. Our country takes credit for organizing women's sanitary care on the battlefield. But is this something to be proud of?
24 medical instructors were awarded the title of Hero of the Soviet Union, including 10 people posthumously. The poet M. Svetlov wrote about them, about the dead:
On a long stretcher, under a canopy
Russian princesses were dying. Machine gunners stood quietly nearby in State Sadness. The Yegoryevsk Medical School in the Moscow region is named after Zinaida Samsonova. She was a fighting friend of Yulia Drunina. The poem “Zinka” is dedicated to her.
We did not expect posthumous glory, We wanted to live with glory. Why is the Blonde soldier lying in bloody bandages? According to generalized data, first aid was provided within the first hour after injury to 66.5% of all wounded, and 88.6% received it in the first 2 hours. This was important to achieve good treatment results. After recovery, 72.3% of the wounded and 90.6% of the sick were returned to duty.
War is over. “You took off your soldier’s overcoat, put on your old shoes” and began your pre-war duties. In 1961, 2 participants of the Great Patriotic War - guard lieutenant colonel of tank forces, writer, Hero of the Soviet Union, Muscovite Irina Nikolaevna Levchenko and surgical nurse, chairman of the primary organization of the Red Cross of the Leningrad Skorokhod factory Lidia Filippovna Savchenko - were awarded the Florence medal for the first time in Russia Nightingale.
Starting from 1954, in accordance with the resolution of the Council of Ministers of the USSR of May 14, the terms of study were unified depending on general training (based on 9- and 11-year education), the network of medical schools was streamlined, and specialization was introduced for nurses in therapeutic nutrition, massage, physical therapy, anesthesiology, etc.
An analysis of changes in nursing during this period shows that the main focus was on educational reform. This is evidenced by fairly frequent revisions of curricula, which differed from each other only in the number of academic disciplines of the “university” set.
From our point of view, this did not in any way affect the activities of practical nurses. Their professional and social status, determined back in 1927, is basically preserved in Russian healthcare to this day. A conscious attitude towards the doctor’s prescriptions, even if it is developed, remains unclaimed among the majority of nurses: the doctor bears responsibility.

Conclusions for nursing development

- History of the development of nursing interconnectedly includes issues of the place and role of a woman in society, her professional abilities and professional self-realization, as well as the formation of various professions.
- The first women's religious organization that was involved in charity was founded in France in 1633.
- One of the factors that hindered the development of nursing in the world was the social status of women. Florence Nightingale made a huge contribution to women's equality. She was the first to draw attention to the significance and features of nursing, which determine its specificity and its separation into an independent type of professional activity. On her initiative, the world's first secular school for training nurses was opened in London in 1860.
- In 1899, the International Council of Nurses was created - the first professional organization of women.
- The first organizer and legislator of nursing in Russia was Peter I, on the basis of whose decrees women’s care work began to be used, and then increasingly specified and specified. At the same time, in the 18th century. Women's participation in care was not systematic. According to the staff, the hospitals had both soldier-sitters and women-sitters.
- In the first half of the 19th century. the service of “compassionate widows” remained the only form of women’s participation in caring for the sick
in Russia. With the establishment of the Institute of Compassionate Widows (1819), the training of female medical personnel began.
- "Management." H. Oppel (1822) was the first work known to us that made an attempt to emphasize the importance of the activities of nursing staff, highlight the specifics of the work of nurses in various specialties, and also outline the structure of activities and professional knowledge.
- The first community of Russian sisters of mercy - Holy Trinity - was created in 1844 in St. Petersburg.
- In 1854, the Exaltation of the Cross community of sisters of mercy was created in St. Petersburg, specifically intended for work in the army. The community charter was drawn up by N.I. Pirogov. During the war, the sisters acquired one of the specialties: surgical nurses (dressing nurses), pharmacists and housewives. History has preserved the names of those great women: D. Sevastopolskaya, E. Bakunina, E. Khitrovo, A. Travina, M. Grigorieva and others.
- In 1867, the Russian Red Cross Society was established. His competence included organizing the training of sisters of mercy and monitoring the establishment and activities of communities of mercy.
- At the beginning of the 20th century, the leadership of charitable institutions was headed by Grand Duchess Elizaveta Feodorovna, who at the end of the century was canonized by the Russian Orthodox Church.
- The movement of communities of mercy is a wonderful example of asceticism. Communities of Sisters of Mercy played a major role in the development of women's intellectual and emotional potential in Russia.
- In 1920, the first state medical schools appeared in Russia. In 1929, the issue of improving nursing staff was resolved, the frequency of which (at least once every 5 years) continues to this day. In 1936, a unified system for training paramedical personnel was introduced.
- During the Great Patriotic War, for the first time in the world, a female medical instructor was placed in the line of fire in the Soviet army. 24 medical instructors were awarded the title of Hero of the Soviet Union, including 10 people posthumously.
- An analysis of changes in nursing shows that from 1945 to 1986 the focus was on educational reform. From our point of view, this did not in any way affect the activities of practical nurses. Their professional and social status, determined back in 1927, is basically preserved in Russian healthcare to this day.
- Some damage to the prestige of the nursing profession has been and is being caused by the fact that a nurse performs the function of a doctor’s assistant, and abroad the concept of partnership between these specialists is increasingly being established.
- The attitude towards a nurse only as a doctor’s assistant and the concept of “paramedical worker” hinders the development of professional self-awareness of nurses. The lack of scientific principles in the system of training nurses and prospects for professional growth gave rise to many problems in Russian healthcare.

White clothes. History of the medical gown

It is noteworthy that with all the variety of versions of the origin of the white medical coat, researchers still cannot agree on who was the first to wear this item of clothing, which has become a symbol of medicine. Let's try and figure it out...

Until the 19th century, surgeons did not wear gowns

Until the second half of the 19th century, surgeons did not use gowns at all. Instead, an apron and sometimes sleeves were worn, and then only by surgeons during major operations. There were no masks or caps. Moreover, doctors did not wear any special clothing, unlike nurses, for whom uniforms had existed for a long time.

The sister's uniform is associated primarily with monastic attire, because in the old days the lot of the “brides of Christ” was caring for the sick, wounded, and crippled. There were no hospitals or clinics as such during the Middle Ages, so those in need of medical care received inpatient treatment at monasteries. The traditional outfit of a sister of mercy in monastery hospitals was this: a dark long dress with a white apron and a white headscarf. In the mid-19th century, the sisters' clothing was dominated by black, and scarves gave way to caps. At the turn of the century, Red Cross sisters wore dresses with white cuffs or sleeves and white caps.

White color is a symbol of salvation

Abbess Ksenia of the Holy Trinity Novo-Golutvin Monastery: “White robes are a symbol of the Savior, a white robe of a doctor is a symbol of one who helps in trouble.”

Only in the 1860s did the English hygienist Joseph Lister develop a whole sound theory of antiseptics, and from this, in general, the history of medical gowns begins. Gradually, gowns, although not always white, and masks appear, and instead of surgical theaters, operating rooms appear.

The first to introduce white coats into permanent practice were probably the Germans during the Franco-Prussian War of 1870. By the beginning of the 20th century, the use of a white coat, cap and mask during surgical procedures was already quite common. But only after the deadly global Spanish flu epidemic in 1918, which claimed the lives of tens of millions of people, did wearing a gown and cap become a widespread phenomenon among not only surgeons, but also doctors of other specialties.

White color is the color of divine purity and high trust. A white medical coat is an integral part of a doctor’s authority, his calling card.

There are other, non-traditional versions of the history of the origin of white coats. For example, an eastern legend assures us that not only the symbol of medicine - a bowl with a snake - is borrowed from the teachings of Ayurveda, but also the modern uniform of a doctor - a white coat, cap, trousers and a face mask. This is exactly what the ritual clothing of the Atharvans, the ancient Zoroastrian healers, looked like. When treating the sick or performing rituals, healers dressed in white as a symbol of purity. The bandage on the face served to prevent their breath from desecrating the sacred creation of fire.

Modern doctors: PROS and CONS of white coats

A study conducted at London's Royal Free Hospital found that most patients preferred doctors wearing white coats, but doctors themselves were reluctant to wear them. In a survey of 276 patients and 86 doctors, white coats were found to be about twice as popular among patients as among medical staff. The main argument of patients is in favor: white coats help to see the doctor from afar. The main argument of English doctors “against”: the gown often becomes a carrier of infections.

Currently, clothing for medical personnel is no less important than tools. It should be comfortable, functional, and command respect. It, as doctors assure, in itself has a beneficial effect on the treatment process, giving confidence to the doctor and instilling faith in the patient. It is not without reason that from time immemorial white coats have served as one of the symbols of the most humane profession.

A survey of doctors showed that only one out of eight doctors believes that wearing a white coat is mandatory. Seven out of ten doctors are confident that this should not be done, because infection can spread through gowns. Six out of ten believe that, in addition, white coats are hot and uncomfortable.

Nowadays there are a lot of requirements for professional medical clothing. It should be ergonomic, blood-repellent, antistatic, bactericidal, etc. It should protect against nosocomial infections, be easy to disinfect, be practical and, of course, stylish, so as not to depress the patient’s condition, so that it is pleasant to wear. Medical fashion designers believe that over time, doctors’ clothing will generally resemble spacesuits. By the way, something similar can be seen today in intensive care units. A recent novelty is fabrics with blood- and water-repellent impregnation. The blood is not absorbed into the robe, but flows down. If blood splashes on your robe, just rinse the area with cold water. The whole world has switched to so-called mixed fabrics, which include cotton and polyester. Mixed fabrics have many advantages: they are hygroscopic, like cotton, they also “breathe”, but they wrinkle much less and do not shrink when washed.

A white robe in a white room - a scene from our childhood nightmares - is slowly becoming a thing of the past. Alas, it seems that soon the classic sterile white color of the medical gown will become history. It is being replaced by more practical violet, orange, green... But, I think, the white robe will still remain a symbol - like the bowl with the snake that has sunk into the past...

When the robe came to Russia

The robe came to Russia in the 18th century, turning first into home and then into work clothes. And only at the turn of the 19th–20th centuries did it become medical!

Before the advent of medical clothing, back in the 19th century, surgeons wore aprons and sleeves. Neither caps nor masks were used, and there was no talk of sterilizing medical instruments. Everything changed only when people learned about the dangers of germs.

For example, Joseph Lister made the discovery in the 19th century that microbes are the cause of many infectious complications. The risk of infection can only be reduced through sterilization. Lister, to combat infections, proposed using phenol to treat hands and clothing. Thanks to his proposal, the mortality rate after surgery has decreased significantly. It was then that they began to create special medical clothing for all medical personnel, including nurses. Honey. The uniform provided additional protection for the doctor and medical staff from contact with various types of contaminants on the skin and protection from infection of the patient.

Initially, only white was used. The white color of clothing symbolized purity during times. However, since 1950, hospitals began to abandon the use of only white medical clothing in operating rooms. The fact is that in brightly lit conditions in operating rooms, the white color of the gowns caused visual strain among doctors and medical staff. The process of conducting operations lost a lot in quality due to this.

Since that time, green and blue medical clothing began to be introduced in medical institutions. It was used primarily by surgeons. These colors reduced visual stress and had a positive effect on the process of operations.

Later, other clothing options appeared in the arsenal of surgeons: short-sleeved jackets and trousers. Since then, medical uniforms have become ergonomic and aesthetically pleasing. Thus, from aprons and sleeves, doctors' attire evolved into comfortable and practical clothing.

Ethics

Content
I. Medical ethics or ethics of life
II. Historical models of moral medicine
1. Hippocratic model (“do no harm”).
2. Paracelsus model (“do good”)
3. Deontological model (the principle of “observance of duty”)

III. Models of moral medicine in modern society
1. Technical type model.
2. Model of the sacred type.

4. Contract type model.
5. The principle of informed consent.
IV. Bibliography

The formation and development of medical ethics (bioethics) is associated with the process of transformation of traditional ethics in general, biological ethics in particular. It is due, first of all, to the sharply increasing attention to human rights (in medicine, these are the rights of the patient, test subject, etc.) and the creation of new medical technologies that give rise to many problems that require solutions, both from the point of view of law and morality.

BIOETICS as a research area of ​​an interdisciplinary nature was formed in the end. 60's - early 70's. The term "BIOETHICS" was proposed by W. R. Potter in 1969.

DEONTOLOGY

Introduction

1. History of the development of the concept of “deontology”.

2. Deontology in the modern world

3. Deontological aspects of scientific

activities

Conclusion

References

Introduction

The solution to the most important tasks - improving the quality and culture of medical care for the population of the country, the development of its specialized types and the implementation of broad preventive measures is largely determined by compliance with the principles of medical deontology (from the Greek “deon” - due and “logos” - teaching) - the doctrine of what is proper in medicine.

Medical deontology is constantly evolving, and its importance is also increasing. The doctor as an individual, socially and psychologically, is not limited to “narrow” medical and preventive activities, but participates in solving complex problems of education and raising the general cultural level of the population.

The importance of medical and psychological aspects of deontology is also increasing, because natural and social consequences of scientific and technological progress lead to an increase in psycho-emotional tension in relationships between people, to various conflict situations and adaptation difficulties. There is an urgent need to study man as a whole - as an object of biosocial nature.

In the process of differentiation and integration of medicine, the formation of its new areas, specialties, and the profiling of individual areas, other, new, no less complex, deontological problems arise. Among them are, for example, the relationship between the surgeon, anesthesiologist and resuscitator in the process of treating a patient, the problem of “doctor-patient-machine”, scientific creativity in connection with the thesis “science today is a collective work”, and finally, complex moral and ethical issues related with current acute scientific problems.

In addition to the general aspects of deontology, regulations and rules related to medicine as a whole, in each specialty there are also narrower, to a certain extent specific, deontological aspects. This is understandable, because in each specific case, many situations that arise during the work of a doctor are resolved individually.

Due to the emergence of complex medical systems, the demands on medical personnel have increased significantly. Each member of the medical staff must not only have perfect medical skills, but also be able to handle modern medical equipment.

But not even the most experienced specialist will be able to adequately assess emerging problems and solve them if an error is inherent in the development of a mathematical model of a disease. In this regard, a huge responsibility falls on the shoulders of the developers of these models. Any mistake when creating a mathematical model can lead to serious consequences. A mathematician working on medical problems is required to have knowledge of both the mathematical and medical aspects of the problem he is trying to solve. This is especially important when creating diagnostic and treatment complexes that allow you to establish a diagnosis and select treatment methods.

1. History of the development of the concept of “deontology”

Medical deontology has gone through a long and complex path of development. Its history is rich in bright, sometimes dramatic events and facts. The origins of deontology go back to ancient times. One might think that the first person who provided medical assistance to his neighbor did it out of a feeling of compassion, a desire to help in misfortune, to ease his pain, in other words, out of a sense of humanity. There is hardly any need to prove that humanity has always been a feature of medicine and the doctor, its main representative. Doctors have always been deeply interested in questions about who a doctor is, what his behavior should be, his attitude towards patients, their relatives, and the relationship between doctors.

The search for thoughts (and disputes) of doctors of many countries and peoples is evidenced, in particular, by Babylonian, Egyptian, Indian, Chinese, Russian and other handwritten monuments of antiquity. They contain important thoughts and statements about many of the qualities required of a true physician. But only the thinker and doctor Hippocrates (c. 460 - c. 370 BC) in his famous “Oath” first formulated the moral, ethical and ethical standards of the medical profession.

The greatness of Hippocrates lies primarily in his humanism, in the fact that he considered man to be the crown of nature. These views permeate the entire text of the Hippocratic Oath.

As W. Penfield puts it, it “contains eternal truths that time cannot change.”

Of course, historical and social conditions, class and state interests of changing eras have repeatedly transformed the “Oath”. But even today it reads as a completely modern document, full of moral force. It is significant that the participants of the 1st International Congress on Medical Ethics and Deontology (Paris, 1969) considered it possible to supplement it with only one phrase: “I swear to study all my life.”

The term “deontology” was introduced into use relatively recently - at the beginning of the last century by the English philosopher I. Bentham

as a designation for the science of professional human behavior. Bentham preached the ideology of bourgeois liberalism. The common good, according to Bentham, is unattainable in conditions of insurmountable antagonism for society, and therefore each person should care only about himself. In other words, Bentham contrasts deontology as a doctrine of personal ought in the behavior of an individual with ethics, the science of morality as a social ought in the behavior and relationships of people. It follows that humanism and humanity are concepts that have no place in human society.

Ideas close to this were preached by the English economist Malthus. According to his theory, the population of the Earth is increasing in geometric progression, but the means of ensuring the existence of people can only increase in arithmetic progression. Consequently, it is impossible to satisfy the needs of all people, and hence poverty and hunger are not due to social reasons, but to biological ones - a certain law of limitless reproduction of living beings. Nature itself regulates the population size and one cannot interfere with its “natural order”. He considered medical practice unnatural, because saving “extra people” prevents natural regulation of population.

Currently, in medicine, the concept of “deontology” is given a fundamentally different meaning. First of all, deontology is understood as the doctrine of duty, the science of the moral, aesthetic, and intellectual appearance of a person who has devoted himself to a noble cause - caring for human health, about what should be the relationship between doctors, patients and their relatives, as well as between colleagues in medical team and entire institutions involved in the fight for people’s lives and health.

There is a certain internal connection between deontology and ethics, and this is understandable, because duty, justice, conscience and honor, the idea of ​​good and evil, and finally, happiness and the meaning of life are ethical categories.

P.A. Holbach defined ethics as the science of relationships between people and the duties arising from these relationships. Consequently, ethics is one of the areas of education that is closely related to deontology, its goals and their practical implementation.

Its interpretation is varied. First of all, they are trying to identify bioethics with biomedical ethics, limiting its content to ethical problems of the doctor-patient relationship. A broader understanding of bioethics includes a number of axiological, social and health care systems issues and human relationships with animals and plants. Moreover, the term "bioethics" indicates that it focuses on the study of living beings, whether they find application in therapy or not. In other words, bioethics is guided by the achievements of modern biology in justifying or resolving moral conflicts that arise in the course of scientific research.

In 1903, V. Veresaev wrote: “...Sad as it may be, we must admit that our science still does not have ethics. One cannot understand by it that special corporate medical ethics, which deals only with normalizing the direct relations of doctors to the public and doctors among themselves. Ethics is needed in a broad, philosophical sense, and this ethics must first of all cover in its entirety the question of the mutual relationship between medical science and a living person. Meanwhile, even partial questions of such ethics are almost never raised in our country and are almost never debated...” Veresaev sees the main task of ethics “... in a comprehensive theoretical clarification of the question of the relationship between the individual and medical science within the boundaries beyond which the interests of an individual can be sacrificed to the interests of science...”. He emphasizes: “...the question of human rights in the face of medical science encroaching on these rights inevitably becomes the fundamental, central question of medical ethics...”.
Unfortunately, what at the beginning of the century was the moral deformity of individual doctors, after 1917 became immoral state policy.

In 1925, People's Commissar of Health N.A. Semashko declared medical confidentiality a relic of old caste medical practice and old stupid prejudices and emphasized that Soviet healthcare was taking “... a firm course towards the destruction of medical confidentiality, a relic of bourgeois medicine...”.

Totalitarianism suppressed human rights and sought to destroy the professional ethics of doctors. He did not even allow discussion of problems of professional ethical standards and, even more so, philosophical problems of medical ethics. But he could not suppress free philosophical and ethical reflections in the works of V. F. Voino-Yasenetsky, V. I. Vernadsky, D. P. Filatov, A. A. Lyubishchev.

In 1940, the outstanding Soviet biologist D. P. Filatov

begins to write the work “Norm of Behavior, or Morality from a Natural Historical Point of View.” Linking ethics with the theory of evolution and ethology, Filatov pursued the idea that man in the first phases of evolution inherited from the animal world the norm of defensive behavior, the egoistic-instinctive principle in behavior. The morality of the future, according to Filatov, will be characterized by an increase in anti-egoistic norms of morality and human behavior. It is noteworthy that D. P. Filatov, while maintaining an orientation towards science, is trying to build an ethics that goes beyond the boundaries of both naturalistic and Christian ethics. He calls his ethics the ethics of love of life.

Summarizing the consideration of ethical concepts developed in Russian thought, one can observe the desire to bridge the gap between morality and life, to root ethics in life. The most important feature of ethical reflection in Russia is the desire to understand the unity of the factors of the evolutionary process and ethical values, to comprehend life in all the integrity of its manifestations. And this general principle of ethics is enlightened by one mentality that permeates all the moral searches of Russian thinkers, the love of life.

II. Historical models of moral medicine.
In order to understand what moral, ethical and value-legal principles underlie modern biomedical ethics, one should at least briefly characterize their development in various historical eras.

1. Model Hippocrates (“do no harm”).
The principles of healing laid down by the “father of medicine” Hippocrates (460-377 BC) lie at the origins of medical ethics as such. In his famous “Oath,” Hippocrates formulated the duties of a doctor to his patient.
Despite the fact that many centuries have passed since then, the “Oath” has not lost its relevance; moreover, it has become the standard for constructing many ethical documents. For example, the Oath of the Russian Doctor, approved by the 4th Conference of the Association of Russian Doctors, Moscow, Russia, November 1994, contains principles that are similar in spirit and even in wording.
2. Paracelsus model (“do good”)
Another model of medical ethics developed in the Middle Ages. Its principles were most clearly outlined by Paracelsus (1493-1541). In contrast to the Hippocratic model, when the doctor wins the social trust of the patient, in the Paracelsian model, paternalism - the emotional and spiritual contact of the doctor with the patient, on the basis of which the entire treatment process is built - acquires primary importance.
In the spirit of that time, the relationship between a doctor and a patient is similar to the relationship between a spiritual mentor and a novice, since the concept of pater (Latin - father) in Christianity extends to God. The whole essence of the relationship between a doctor and a patient is determined by the good deed of the doctor; the good, in turn, is of divine origin, for all Good comes from above, from God.
3. Deontological model (the principle of “observance of duty”).
This model is based on the principle of “observance of duty” (deontos in Greek means “due”). It is based on the strictest adherence to moral requirements, compliance with a certain set of rules established by the medical community, society, as well as the doctor’s own mind and will for mandatory compliance. Each medical specialty has its own “code of honor”, ​​non-compliance with which is fraught with disciplinary action or even exclusion from the medical profession.
4. Bioethics (the principle of “respect for human rights and dignity”).
Modern medicine, biology, genetics and corresponding biomedical technologies have come close to the problem of predicting and managing heredity, the problem of life and death of the body, control of the functions of the human body at the tissue, cellular and subcellular level. Some of the problems facing modern society were mentioned at the very beginning of this work. Therefore, the issue of respecting the rights and freedoms of the patient as an individual is more pressing than ever; compliance with the patient’s rights (the right to choice, the right to information, etc.) is entrusted to ethical committees, which have actually made bioethics a public institution.

III. Models of moral medicine in modern society.
Let us consider the historical models discussed in the previous section as “ideal” and consider more real models that include some legal aspects of the described relations.
Most problems arise in medical practice where neither the patient’s condition nor the procedures prescribed to him in themselves give rise to them. In everyday contacts with patients, most unusual moral situations do not arise.
The most important problem of modern medical ethics is that health care should be a human right, and not a privilege for a limited number of people who can afford it. Today, as indeed before, medicine does not follow this path. However, this norm, as a moral requirement, is gaining increasing recognition. Two revolutions contributed to this change: biological and social. Thanks to the social revolution, health care has become the right of every person. Individuals must be treated as equals in that which relates to their human qualities - dignity, freedom, individuality. Taking into account the human right to health care, historically established models of moral relations “doctor-patient” and the state of modern society, we can formulate the following four synthetic models of relations between doctor and patient.
1. Model of the “technical” type.
One of the consequences of the biological revolution is the emergence of the physician-scientist. Scientific tradition instructs the scientist to “be impartial.” He must rely on facts, avoiding value judgments.
Only after the creation of the atomic bomb and medical research by the Nazis, when no rights were recognized for the subjects (experiments conducted on concentration camp prisoners), did humanity realize the danger of such a position. A scientist cannot be above universal human values. In the decision-making process, a doctor cannot avoid judgments of a moral and other value nature.
2. Model of the sacred type.
The opposite of the model described above is the paternalistic model of the “doctor-patient” relationship. Sociologist of medicine Robert N. Wilson characterizes this model as sacred.
The basic moral principle, which expresses the tradition of the sacred type, says: “When providing assistance to a patient, do not harm him.” In the classical literature on medical sociology, images of a parent and a child are always used in the relationship between a doctor and a patient.
However, paternalism in the sphere of values ​​deprives the patient of the ability to make decisions, shifting it to the doctor. Therefore, for a balanced ethical system it is necessary to expand the range of moral standards that a physician must adhere to.
1) To benefit and not cause harm. No person can relieve the moral obligation to benefit and yet completely avoid causing harm. This principle exists in a broad context and constitutes only one element of the whole set of moral duties.
2) Protection of personal freedom. The fundamental value of any society is personal freedom. The personal freedom of both the doctor and the patient must be protected, even if it seems that some harm may result. The opinion of any group of people cannot serve as an authority in deciding what is beneficial and what is harmful.
3) Protection of human dignity. The equality of all people in their moral qualities means that each of them has basic human virtues. Personal freedom of choice, control over one's body and one's life contributes to the realization of human dignity - this is an ethics developed beyond the ideas of B. F. Skinner.
4) “Tell the truth and keep promises.” The moral duties of telling the truth and keeping promises are as common sense as they are traditional. One can only regret that these foundations of human interaction can be reduced to a minimum in order to comply with the principle of “do no harm.”
5) “Observe justice and restore it.” What has been called a social revolution has increased public concern about the equality of distribution of essential health services. In other words: if health care is a right, then it is a right for everyone.
A negative feature of this model is that compliance with all the above principles is entrusted exclusively to the doctor, which requires the highest moral qualities from him. Unfortunately, now such an approach in the provision of medical services is difficult to implement due to the high level of discrimination on various grounds (racial, material, gender, etc.).
3. Collegial model.
Trying to more adequately define the doctor-patient relationship while preserving fundamental values ​​and responsibilities, some ethicists say that the doctor and the patient should see each other as colleagues striving for a common goal - to eliminate the disease and protect the health of the patient.
It is in this model that mutual trust plays a decisive role. The hallmarks of a community of common interest originated in the free clinic health movement, but ethnic, class, economic, and value differences among people make the principle of common interest necessary for a collegial model difficult to achieve.
4. Contract type model.
The model of social relations that most closely corresponds to real conditions, as well as to the principles of the “bioethical” historical model described above, is a model based on a contract or agreement. The concept of a contract should not be given any legal meaning. It should be interpreted rather symbolically as a traditional religious or marriage vow, which implies adherence to the principles of freedom, personal dignity, honesty, fulfillment of promises and justice. This model allows us to avoid the refusal of morality on the part of the doctor, which is characteristic of the “technical” type model, and the refusal of morality on the part of the patient, which is characteristic of the sacred type model. It avoids false and uncontrolled equality in the collegiate model. In a relationship based on a “contract,” the doctor recognizes that in cases of meaningful choice, the patient must retain freedom to control his life and destiny. If the doctor cannot live in harmony with his conscience, having entered into such a relationship, then the contract is either terminated or not concluded at all.
In the contract model, the patient has a legitimate belief that the underlying value system used in making medical decisions is based on the patient's own value system, and the many different decisions that the doctor must make daily in providing care to patients will be made in accordance with with the patient’s value ideals.
In addition, the contract-type model implies moral integrity of both the patient and the doctor. Decisions are made by health professionals based on trust. If trust is lost, the contract is terminated.

V. Principle of informed consent.
The “guardian” model of relationships between people is losing its position in public life. Taking its start in politics, the idea of ​​partnership penetrated into the most intimate corners of human life.
Medicine was not left behind either. Paternalism, which traditionally reigned in medical practice, is giving way to the principle of cooperation. The moral value of autonomy has turned out to be so high that the doctor’s beneficence against the will and wishes of the patient is now considered unacceptable.
The center of the movement for patients' rights was the hospital, symbolizing all modern medicine with its ramifications, saturated with various equipment and - the increased vulnerability of the patient.

Informed consent refers to the patient's voluntary acceptance of a course of treatment or therapeutic procedure after the doctor has provided adequate information. We can roughly distinguish two main elements of this process: 1) providing information and 2) obtaining consent. The first element includes the concepts of voluntariness and competence.
The doctor is obliged to inform the patient:
1) about the nature and purposes of the treatment offered to him;
2) about the significant risk associated with it;
3) about possible alternatives to this type of treatment.
From this perspective, the concept of an alternative to a proposed treatment is central to the idea of ​​informed consent. The doctor gives advice on the most appropriate option from a medical point of view, but the final decision is made by the patient, based on his moral values. Thus, the doctor treats the patient as an end and not as a means to another end, even if that end is health.
Particular attention is also paid to the risks associated with treatment when informing. The physician must address four aspects of the risk: its nature, its severity, the likelihood of it materializing, and the suddenness of its materialization. But at the same time, the question arises: How and to what extent to inform the patient? The “subjective standard” of information, which requires clinicians to tailor information to the specific interests of the individual patient as much as possible, has received much attention recently.
From an ethical point of view, the “subjective standard” is the most acceptable, since it is based on the principle of respect for patient autonomy and recognizes the independent information needs and desires of a person in the process of making difficult decisions.
In the initial period of formation of the doctrine of informed consent, the main attention was paid to the provision of information to the patient. In recent years, scientists and practitioners have become more interested in the problems of patient understanding of the information received, as well as achieving agreement on treatment.
Voluntary consent is a fundamentally important point in the medical decision-making process. The voluntariness of informed consent implies the non-use of coercion, deception, threats, etc. on the part of the doctor. when making a decision by the patient. In this regard, we can talk about expanding the scope of morality, moral assessments and requirements in relation to medical practice. The truth, albeit cruel, receives priority in medicine today. The doctor has a duty to be more honest with his patients.
Competence in bioethics refers to the ability to make decisions. There are three main standards for determining competence:
1) the ability to make decisions based on rational motives;
2) the ability to achieve reasonable goals as a result of a decision;
3) the ability to make decisions in general.
Thus, the fundamental and most important element of competence is this: a person is competent if and only if that person can make acceptable decisions based on rational motives. That is why the problem of competence is especially relevant for psychiatry.
There are two main models of informed consent - event-based and procedural.
In the event model, decision making means an event at a certain point in time. After assessing the patient's condition, the doctor makes a diagnosis and creates a recommended treatment plan. The physician's opinion and recommendations are provided to the patient along with information about the risks and benefits, as well as possible alternatives and their risks and benefits. After weighing the information received, the patient considers the situation and then makes the medically appropriate choice that is most consistent with his or her personal values.
In contrast, the procedural model of informed consent is based on the idea that medical decision-making is a long-term process and that information must be exchanged throughout the physician-patient interaction. Treatment here is divided into several stages, which can be characterized by the main tasks they pose:
1) establishing relationships;
2) defining the problem;
3) setting treatment goals;
4) choice of therapeutic plan;
5) completion of treatment.
In this model, the patient plays a more active role compared to the relatively passive role in the event model.
In general, the turn to the doctrine of informed consent was made possible by a revision of the concept of the purposes of medicine. Traditionally, it was believed that the first goal of medicine was to protect the health and life of the patient. However, often the achievement of this goal was accompanied by a denial of the patient’s freedom, and therefore an infringement of his personal freedom. The patient became a passive recipient of the benefit.
The main goal of modern medicine is the well-being of the patient, and restoration of health is subordinated to this goal as one of the constituent elements.
Respect for individual autonomy is one of the fundamental values ​​of a civilized way of life. Any person is interested in making decisions that affect his life independently.
Thus, today the self-determination of the individual is the highest value, and medical care should be no exception
Bioethics, which emerged about 20 years ago, was a response to the so-called “problem situations” in modern clinical practice. A broad discussion of “problem situations” in modern society has become a manifestation of the ideology of protecting human rights in medicine. In connection with the latter circumstance, some fundamental problems of bioethics turned out to be extremely close in content to the moral and ethical dilemmas that arise when providing medical care.
The dilemma of paternalistic and non-paternalistic approaches in modern medicine is a “red thread” for all bioethics. The paternalistic model of the relationship between the doctor and the patient is based on the fact that human life is a priority value, “the good of the patient is the highest law” for the doctor, and the doctor takes full responsibility for making clinical decisions. On the contrary, the non-paternalistic model is based on the priority of the patient’s moral autonomy, due to which the category of patient rights becomes key.

PROBLEMS OF NURSES

Valentina Sarkisova: a modern nurse is a full participant in the treatment process.

According to the “Concept for the development of healthcare in the Russian Federation until 2020,” there is a decrease in the level of provision of the population with paramedical personnel. Today the deficit is more than 850 thousand people. There are many reasons for this: low wages, very high workloads, low prestige of the profession, etc. Valentina Antonovna Sarkisova, President of the Russian Nurses Association, spoke about possible methods of overcoming the “personnel impasse” and changing the role of the nurse in the ICU.

The modern role of the nurse is different than it was a few years ago. Today, a nurse must be a professionally competent and qualified participant in the treatment process, and not just a silent doctor’s assistant who carries out his instructions “automatically.” This is the demand of the time. It is the nurses who take care of the patient: they nurse them, help them get back on track, work with the patient’s relatives, explaining and showing how to properly help their loved one after he is discharged from the hospital. After all, no one can tell you better about all the intricacies of the procedures being performed than a nurse. Even a doctor!

Today, nurses are sufficiently qualified to provide highly qualified care to patients and advise their families (for example, on the use of clinical nutrition). Moreover, in the process of work they have a chance to improve their professional skills, gaining new practical and theoretical knowledge. For example, the Association of Russian Nurses often holds and participates in a large number of forums, training conferences and seminars both in Russia and abroad. The Association is a member of a number of international organizations and WHO, and is also involved as an expert by the Ministry of Health of the Russian Federation in the development of professional standards.

However, despite all the positive aspects, in practice the role of the nurse in the ICU remains underestimated, and the prestige of the profession is not at the highest level. This is due to both the attitude towards nursing staff and working conditions. Hence the shortage of personnel, which is felt in almost all departments. Even in the therapeutic departments of many hospitals, the staff shortage is 45-46%.

Today it has become obvious that the level of wages does not correspond to the high loads that fall on the shoulders of nurses. According to current regulations, in ICU departments there is one nurse per patient. “However, in practice, there are usually 6-8 severe patients per nurse,” notesPresident of the Russian Nurses Association V.A. Sarkisova . “The extremely low wages for nurses make their situation even more difficult. Nurses working at 1.5 rates in Moscow receive about 17-18 thousand rubles. In the regions, these figures are approximately 2 times lower. Of course, low salaries and high workloads negatively affect the level of quality of care provided. In addition, due to the new remuneration system, which equated intensive care unit nurses to ordinary ward nurses, most of the nurses left and only those who were devoted to their profession remained,” explains the current situation in the industryV.A. Sarkisova .

It is absolutely impossible to equate these two categories of nurses with each other due to the difference in their qualifications. The level of competence of an ICU nurse goes far beyond the ward nurse. It is obvious that the level of knowledge and skills of an ICU nurse is much higher than that of an ordinary ward nurse due to the fact that she has to care for extremely seriously ill patients, monitor vital functions, and observe the readings of absolutely all monitors and devices that currently exist in intensive care unit.

At the same time, we must pay tribute, the Ministry of Health is taking certain steps to improve the professional situation of nurses. In particular, a special program has been developed, the purpose of which is to improve the working conditions of nursing staff and resolve social issues. The program also stipulates the requirement for gubernatorial bonuses for nurses and paramedics if, for example, they go to work in rural health authorities. That is, the dialogue between the authorities and the social movement began to improve. “The social movement has great potential and many resources to make a significant contribution to the development of Russian healthcare,” notes

http://ww © Kunkite M.I. 2006.
© 2006.

w.sister VII. Bibliography
1. Siluyanova I.V., “Modern medicine and Orthodoxy”, M., Moscow Compound of the Holy Trinity Sergius Lavra, 1998.
2. Journal “Questions of Philosophy”, No. 3, 1994
3. Modern philosophy: dictionary and reader. "Phoenix", Rostov-on-Don, 1995.
4. Philosophy. Textbook for higher educational institutions. "Phoenix", Rostov-on-Don, 1995.

Find material for any lesson,

Ministry of Health of the Republic of Bashkortostan

Bashkir Medical College

on the topic: “History of nursing.”

Completed by: 2nd year student, 22nd grade.

Zabirova Rosalia.

"History of Nursing".

The Origins of Mercy and Care for the Sick and Wounded

The feeling of love for one's neighbor has been inherent in man throughout all centuries. According to the Christian religion, a neighbor is one who is created in the image and likeness of God, that is, all people. One of the many manifestations of love for others was caring for the sick. Moreover, women, to a greater extent than men, had to care for the sick.

Among the peoples of the Ancient World, relatives cared for the sick. There were no special people who would devote themselves to caring for the sick, the only exception being women involved in providing assistance to mothers and newborns. At first these were elderly relatives, but over time special specialists appeared. The organization of such assistance reached its greatest development among the Greeks and Romans.

In Ancient Greece there were midwives, which, according to Hippocrates, could only be women who gave birth, as well as women with extensive life experience. They determined the timing of pregnancy and the onset of childbirth, and they were given the right to speed up childbirth with medicines and sacred songs. Midwives also treated women's diseases and were even matchmakers. A separate group consisted of female doctors who also dealt with women’s diseases. Many of the women doctors and midwives were in government service. But obstetrics was especially developed in Ancient Rome. Here, midwives not only provided assistance during childbirth, but also cared for women in labor and babies.

Soranus of Ephesus, in his treatise on gynecology, drew attention to the fact that women who wish to engage in obstetrics should be literate, “active, decent and have normal sense organs, be healthy and strong, have long thin fingers with short-cut nails.” If the midwives were not particularly young, he recommended that they “be constantly sober, calm and silent, not be superstitious, and not use abortifacients for selfish purposes.”

In Athens and Rome, sick poor people and soldiers wounded in battle were treated in the homes of wealthy citizens, where women cared for them. However, the work of caring for the sick was fully developed only with the spread of Christianity. The disciples of Jesus Christ - the apostles - not only preached Christian teaching, but also healed the sick. The care of the sick and poor was taken upon primarily by women, who were called deaconesses, as well as men (deacons), who voluntarily devoted themselves to selfless care for the sick and wounded.

Almshouses, or “diaconies,” began to appear at churches and monasteries, initially intended for sick monks and nuns, and later for all sick people. Even among the first Christians, caring for the sick in these institutions was considered a charitable work; almost all members of the community devoted themselves to it, but mainly women and deaconesses. Even then, it was noticed that at the patient’s bedside, women more often than men show restraint and more easily endure restless nights and days full of worries and worries about the patient.

Christian care for the sick since the time of the Roman emperor Constantine the Great (IV century AD), who supported the Christian religion, has taken on a new form - public hospitals and hospitals for the sick and homeless are established.

The creation of communities of women and girls to serve the cause of mercy and care for the sick dates back to the 11th century in many cities of Western Europe (the Netherlands, Germany, etc.). The annals of these countries mention many women, even belonging to the princely family, who devoted their lives to caring for lepers in the first public hospitals. Thus, in the 13th century, Countess Elizabeth of Thuringia, who was distinguished by her deep religiosity and love for people, devoted her entire life to serving the cause of mercy. At the age of 20, she built a hospital with her own funds and organized an orphanage for foundlings and orphans, where she herself worked a lot.

In 1235, Elizabeth was canonized and a Catholic community of “Elizabethans” was founded in her honor - from those who wished to follow her example. In peacetime, the community sisters cared only for sick women, and in wartime, they also cared for men in need of medical care. The community also did a lot for those suffering from leprosy.

Christian charity in the Middle Ages in Catholic countries was also expressed in the creation of various secular and spiritual orders of knighthood, whose members considered caring for the sick as their main goal. For example, the main function of the Order of St. Lazarus (hence the infirmary) in Jerusalem was to care for lepers. The Knights Templar in France and the German knights patronized pilgrims and cared for the sick and poor. Women could also become members of the order.

The main concern of the order, founded in Jerusalem and named after St. John, was the care and care of the sick. Its first abbess in 1099 was the Roman Agnes. The sisters vowed to spend all their time caring for the sick, fasting and prayer, and working for the good of the order. The activities of the women of this order spread to Italy, Spain, France, and England, where they created monasteries.

The activities of the “St. John” community in Paris became especially famous. In 1348, during the great plague epidemic, members of the community showed an example of self-sacrifice. Contemporaries of these events described the following picture: “The patient, abandoned by everyone, lay alone with his torment. Relatives were afraid to approach him, the doctor was afraid to enter his home, and even the priest only gave him communion with fear. With groans that tore their hearts, children called for their parents, fathers and mothers - sons and daughters. But in vain! The relatives even touched the corpses only because no one agreed to fulfill their last wishes for money... nothing could bring together relatives and friends for the burial ceremony. graves of the poorest people, because inexpressible fear repelled their friends and comrades from the grave." All the more significant are the numerous examples of self-sacrifice of the sisters of the orders when providing assistance to the sick. In Paris alone, more than 500 sisters of these orders died during the epidemic, but other sisters continued to do this dangerous work.

The sisters of the order, the so-called “hospitaliers,” also did a lot to care for the sick. These sisters were in charge of large hospitals - St. Louis in Paris, as well as in other cities of France. Only one Hotel-Dieu (house of God) in the capital accommodated 6,000 patients; Patients with any diseases, even contagious ones, were admitted here.

In 1617 in France, priest Vincent Paul organized the first community of sisters of mercy. This year in the city of Chatignon, in one of his sermons, he drew the attention of parishioners to the extremely difficult financial situation of one poor family, whose members were sick. Struck by the preacher’s eloquence, the listeners (and especially the women) began to help not only this family, but also all the sick in the parish. For the proper distribution of assistance, Vikenty Paul decided to organize a society and began to draw up a charter. “Charity towards one’s neighbor,” says this charter, “is the surest sign of a Christian, and one of the main acts of mercy is visiting the poor, the sick and helping them in every way.” At first the society was called the “society of mercy,” and its members were called “ministers of the poor.” They had to take turns daily taking the necessary provisions from the common warehouse, preparing food from it and delivering it to the sick. But the task of this society was not only to provide material and physical assistance, but also spiritual. “Servants of the poor” tried to teach the sick to live better and die with dignity, so they combined their visits with religious conversations, reading and instructions.

In Germany, communities of sisters of mercy were created back in 1808. In Italy, sisters of mercy appeared only in 1821. Their main task was to care for infectious patients who were not accepted by hospitals. Twice a week they visited patients with chronic diseases at home and provided them with food and medicines prescribed by doctors.

The first communities of sisters of mercy in Austria were organized in 1834, in the Czech Republic - in 1837. By the middle of the century, there were already about 16 thousand sisters of mercy in Western Europe.

In 1841, communities of deaconesses were organized in the USA, and in 1851 - in the East, where many hospitals and educational institutions were run by the communities (in Beirut, Jerusalem, Alexandria). In 1884, there were only 56 communities in the world, mostly Protestant, of which 35 were in Germany, 6 in Russia, 3 in Switzerland, 3 in France, 2 in Holland, 2 in England and one community each in Hungary, Denmark, Sweden, Norway and the USA. By the end of the 19th century, there were 60 communities of deaconesses, uniting more than 8,000 sisters. Their charitable activities were carried out in 1,780 institutions. Similar communities existed in Protestant churches in Russia - in St. Petersburg, Saratov, Vyborg, Riga, Tallinn, Helsinki.

Beginning in the mid-19th century, Catholic nuns and Protestant deaconesses provided medical care and care for the wounded during military operations. On a fundamentally new organizational basis and at a higher quality level, women's labor began to be used in providing medical care to the wounded during the Crimean War (1853-1856).

Organization of patient care system

In 1763, the famous Russian educator I. I. Betskoy proposed creating a system of institutions in Russia for the education and professional training of foundling children. The idea was approved by Empress Catherine II. She published a manifesto on the creation of an orphanage in Moscow on a charitable basis and was the first to contribute 100 thousand rubles.

The correct organization of the work of educational homes for the education and professional training of their pupils gave positive moral and material results. In 1803, in St. Petersburg and Moscow, with funds from educational homes, two hospitals for the poor with 200 beds each were established, with the goal of “providing free medical benefits of every condition, gender and age and every nation to the poor and indigent patients, judging by the type and degree of illness : either leaving the sick for treatment in the hospital, or supervising those who come daily for advice and medicine." In 1828, after the death of the Empress, these hospitals were named Mariinsky in her honor.

In the same year, on May 12 in Moscow and August 30 in St. Petersburg, widows' homes were officially opened “to provide care for the elderly and those without the means to support their widows.” Their establishment became an outstanding act of charity not only in Russia. The St. Petersburg widow's home included: 1) a department for young children; 2) an orphanage for noble children; 3) a charity home for sick girls of noble rank; 4) a shelter for children whose parents suffered from the floods of 1824; 5) a shelter for children whose parents died from the cholera epidemic of 1831; 6) a school for orphans of military personnel.

Communities of Sisters of Mercy

The organization of care for the sick in our country is closely related to the activities of sisters of mercy communities. As mentioned, in 1844 there were 56 communities of sisters of mercy in the world, of which 35 were organized in Germany, 6 in Russia (St. Petersburg, Vyborg, Saratov, Riga, Tallinn, Helsinki) and 1-3 communities each in other countries. The first such structures in our country were created through private charity. In March 1844, in St. Petersburg, on the initiative and at the expense of Grand Duchess Alexandra Nikolaevna and Princess Theresa of Oldenburg, the first Orthodox community of sisters of mercy in Russia was founded (since 1873 - the Holy Trinity community of sisters of mercy in honor of the existing church in the community Holy Trinity). According to the community’s charter, which was approved in 1848, its goal was “to care for the poor sick, to console the grieving, to bring those who indulged in vices to the true path, to educate homeless children and to correct children with bad inclinations.” The community included: a department of sisters of mercy; women's hospital; almshouse for incurable patients; reform school; boarding house; shelter for incoming children; department of "repentant Magdalenes". Widows and girls of all classes aged from 20 to 40 were accepted into the community. Before receiving the title of sister of mercy, women had to work in the community for a year. The procedure for enrollment as a sister of mercy took place in a solemn atmosphere, just like during the initiation of compassionate widows. After the liturgy performed by the Metropolitan of St. Petersburg, a golden cross with an image on one side of the Most Holy Theotokos with the inscription “Joy of all who mourn” was placed on each sister accepted. , and on the other - with the inscription "Mercy". The one being accepted as a sister took an oath, which contained the following words: “... I will carefully observe everything that, according to the instructions of the doctors, will be useful and necessary for restoring the health of the sick people entrusted to my care; anything harmful to them and prohibited by the doctors will be removed from them in every possible way.” . According to the Charter, sisters of mercy were not supposed to have their own clothes, furniture, or money. “Everything that a sister can receive for her services in gifts or money,” the Charter said, “belongs to the community.” If there were violations, the sister was expelled from the community according to the Charter, but there was no such case in the history of the community. When the community was created, the number of sisters of mercy was determined to be 30, and the number of subjects - 20 people. During the year, 3-4 people received the title of sisters of mercy. The community almshouse had 6 beds for incurable patients; there were 70 places for orphans and poor children; 20 children studied at the reform school; In the first 11 years alone, there were 446 people in the “penitents” department. There was a community supported by charitable funds. In the 50s, the community was going through a difficult period - the economy fell into disarray, the discipline of the sisters worsened, and the question of its closure arose. However, since 1859, when the community was headed by E. A. Kublitskaya, its activities began to revive. The professional training of nurses included training in basic hygienic rules for caring for the sick and some medical procedures. Subsequently, the range of their responsibilities was significantly expanded. In addition to working in the community departments, sisters of mercy selflessly cared for the sick in low-income and poor families.

The women's hospital at the community was organized with 25 beds, and since 1868 it already had 58 beds. In 1884, a men's hospital with 50 beds was opened. Over the years, famous doctors worked in the community as teacher-consultants: N. F. Arendt, V. L. Gruber, N. F. Zdekauer, N. I. Pirogov, E. V. Pavlov, V. E. Eck, the first female doctor N.P. Suslova.

The Pokrovskaya community of sisters of mercy was founded in 1859 in St. Petersburg by Grand Duchess Alexandra Petrovna. According to the charter (1861), the purpose of the community was “to care for the incoming sick, to train experienced nurses and to educate poor and homeless children.” The community included a department for nurses, a hospital, a hospital for outpatients, a pharmacy, a department for infants, a department for young children, a school for boys, and a school for training paramedics. There were 35 people working in the nursing department. As a rule, girls and widows aged 17 to 40 were accepted here. The probationary period was 3 years, after which, in a solemn atmosphere, after taking an oath, the sisters received a gold cross on a blue ribbon with the inscription “Love and Mercy.” Sisters, subjects and students of the school for paramedics were on duty in the hospital, outpatient clinic, pharmacy and were obliged to carry out the orders of the doctors. The community hospital had 20 beds for adults and 30 for children. The hospital for outpatients provided free assistance from consultant doctors on the hospital staff. The department for young children was designed for 98 people of both sexes. Orphans, cripples, blind children, and children from poor families were accepted here. The boys' school educated 40 students who remained in the community until they were 12 years old. The school trained 100 paramedics; training included two stages - preparatory (gymnasium) and special (medical). The curriculum included the study of anatomy, physiology, physics, pharmacology, clinical disciplines, minor surgery, desmurgy, and methods of patient care. The course of study was 4 years. Those who graduated from the school of nurses received a certificate giving them the right to work as a doctor’s assistant.

In 1866, Princess N.B. Shakhovskaya created the community of sisters of mercy “Quench My Sorrows” (the name of the icon of the Mother of God). The community created at the prison hospital later opened an orphanage for girls, a hospital and an outpatient clinic. Subsequently, the community became the largest in Russia; in 1877 it consisted of 250 sisters of mercy.

A special place in the activities of the first communities of sisters of mercy is occupied by the Exaltation of the Cross community, which was established in St. Petersburg at the very beginning of the Crimean War on the initiative of Grand Duchess Elena Pavlovna (the day of the creation of the community - November 5, 1854 coincided with the Orthodox holiday of the Exaltation of the Holy Cross - a symbol of Christian faith). It was the world's first female medical unit to provide care to the wounded on the battlefield. Helping the wounded by the sisters of mercy of this community was the prototype of the activities of the future Red Cross Society.

Having analyzed the experience of the first communities of sisters of mercy, it can be noted that there were no fundamental differences in their activities. The constant qualities of the sisters were strict morality, love and mercy for others, hard work and dedication, discipline and unquestioning submission to superiors. The charters of the communities, although they were strict, but, unlike the monastic ones, retained some elements of freedom for the community members. The sisters had the right to inherit and own their own property, and if they wished, they could return to their parents or marry. Among the sisters of mercy there were many women and girls of noble origin. However, the charter did not allow anyone to make “discounts”, and no one sought privileges; everyone with equal dedication endured the hardships of everyday work in peacetime and the hardships and dangers of front-line life.

On the other hand, it should be emphasized the social orientation of nursing, midwifery and paramedic care in Russia, which was primarily intended for the poor, pregnant women, newborns, children, the elderly, the sick and wounded. In addition, it was aimed at providing assistance to victims of wars, natural disasters, and epidemics. Not only was care and physical assistance provided to the sick, wounded, orphaned child, but humanitarian and vocational education was organized (shelters and schools in the community). Everything that can be called the modern term “social rehabilitation and adaptation”.

The division of spheres of activity in providing assistance can also be traced: assistance in hospitals and clinics took place under the supervision of a doctor and was dependent on him, since the doctor considered a nurse, a patient or a compassionate widow as “an instrument on the fidelity and accuracy of which the success of treatment depends”: the work of nurses in shelters and almshouses were less dependent on the doctor, provided more independence in actions, since, in addition to care, it implied training and instilling skills, including professional ones.

The organization of nursing care, aimed mainly at socially disadvantaged groups of the population, was cost-effective. Thus, the activities of educational homes, whose income significantly exceeded expenses, made it possible to open hospitals for the poor with the funds they earned. The development of nursing and midwifery care was supported by society and the state.

In 1854, during the Crimean War, the siege of Sevastopol began.

On the morning of November 6, the first group of community sisters went to the front. On November 22, after short-term training, the second group of sisters of mercy went to Crimea. By the beginning of 1856, more than 200 sisters of mercy from the Holy Cross community were already working at the theater of military operations.

In his letter on December 6, 1854, N.I. Pirogov wrote: “Five days ago, the Holy Cross community of sisters of Elena Pavlovna, numbering up to thirty, came here and zealously set to work; if they work like they are now, they will bring, no doubt, there is a lot of benefit."

For the first time in this war, which N.I. Pirogov called “the great drama,” nurses began to do what in our time is designated as the function of protecting the patient, and they began to be considered as the patient’s advocates. It was the sister who represented and defended the interests of the patient. Here is how N.I. Pirogov wrote about this work of the sisters of mercy: “They alternately visit hospitals day and night, help with dressings, are also present during operations, distribute tea and wine to the sick and watch the ministers and caretakers and even the doctors. The presence of a woman, neatly dressed and helpfully, enlivens the deplorable vale of suffering and misfortune. But the compassionate empresses must still arrive... the order of these widows is also entrusted to me.”

In another letter, he noted: “They put the neglected hospital back on its feet in such a way that now you won’t recognize it. They put the caretaker under investigation, and started monitoring duty for the nurses.” It is no coincidence that E.M. Bakunina, noting this work of the sisters of mercy, spoke of them as “intercessors” for the interests of the sick and wounded.

Since the end of December, most of the nurses were unable to continue working in hospitals due to typhus; the rest looked after sick sisters. Women who re-entered the community underwent special medical courses for 2-3 months at the St. Petersburg infantry hospital, and then were also sent to the theater of military operations.

On January 13, 1855, a detachment of 12 sisters arrived in Sevastopol, led by the elder sister M. Merkulova, they were entrusted with the most difficult work - duty (day and night) at the main dressing station and in a temporary hospital. N.I. Pirogov divided the sisters into several groups and developed instructions for each group regulating their activities. A group of dressing nurses carried out daily duty in hospital departments, assisted doctors with dressings and operations, and monitored the cleanliness of the wards. According to the instructions, the nurse is obliged to seriously prepare for dressings and select the necessary medications and dressings for the work. When dressing, she had to pay attention to changes in the wound and the surrounding tissue; If severe redness, purulent swelling or bleeding occurs, you should immediately report this to your doctor.

Particular attention in the instructions was paid to measures to prevent infection of wounds; in particular, it was stated that only clean sponges, specially taken from the pharmacist sister, could be used.

N.I. Pirogov in one of his letters describes in great detail the activities of the sisters. On his initiative, for the first time in the history of military field surgery, nurses and doctors were divided into four groups. The first group was responsible for sorting those arriving by severity of wounds, and those who needed urgent surgery were immediately transferred to the second group. The third group cared for the wounded who did not require urgent surgical treatment. The fourth group, consisting of only sisters and a priest, cared for the hopelessly ill and dying. Finally, two housewife sisters were busy distributing wine, tea or broth to the wounded. The housewife sisters kept all the provisions. This was the first “specialization” among sisters, taking into account the level of their knowledge and abilities, as well as the practical need for this type of activity.

The sisters had to work in terrible conditions. Every day, according to Pirogov, from 150 to 200 amputations and other severe operations were performed. Often the wounded were located in hospital tents. Once, Pirogov recalled, a downpour broke out over this martyr camp, soaking through not only the people, but also the mattresses under them. When anyone entered these infirmary tents, cries for help were heard from all sides. And the sisters of mercy, kneeling in puddles in front of the sick, provided them with all possible help.

According to eyewitnesses, many nurses, helping surgeons, looked so closely at various operations that any of them could have performed amputation themselves. The sisters did not leave the wounded French, who were not considered enemies, without care. Having taken on backbreaking labor and a heavy cross, the sisters of the Holy Cross community, “reluctantly, served the operators, chloroformed the operated patients, monitored the pulse, held the arm or leg that the operator was cutting or sawing, pressed their fingers instead of a tourniquet on the artery indicated by the surgeon, and even imposed ligature onto a vessel from which arterial blood oozed after the leg was taken away.”

Despite the fact that the first nurses were recruited with great haste and many of them had no education, they all quickly learned nursing and became models of professionalism.

In addition to medical work, the sisters monitored the activities of the quartermasters. This was due to the fact that state money allocated for hospitals was stolen, in the apt expression of N.I. Pirogov, “even during the day.” Thus, according to N.I. Pirogov, the nurses had a new function - “moral control” over the actions of the hospital administration. E. P. Kartseva, who arrived in Crimea in 1855 and later became one of the most famous sisters, put a lot of effort into the fight against hospital embezzlers who stole from the sick and wounded. For selfless care of the wounded and sick, 158 participants in the Crimean War were awarded medals “For the Defense of Sevastopol” and a gilded cross.

An example of heroism and dedication during the Crimean War (1853-1856) is Dasha Sevastopolskaya (Mikhailova), the first Russian sister of mercy, who helped the sufferers free of charge, using ordinary vinegar to bandage wounds as a means of disinfection.

Dasha Sevastopolskaya was an orphan, her father died in the war at the Battle of Sinop, and her mother died. She sold her inheritance, dressed as a cabin boy and went to war. Nobody recognized her as a girl. The Emperor awarded her a gold medal “For Diligence,” ordered the Grand Dukes to kiss her, gave her five hundred rubles, and promised another thousand when she got married, and he kept his promise.

The Crimean War showed the benefits of female care for the wounded and sick, which was carried out by the warring parties. Based on the experience of the Crimean War, N. I. Pirogov will write something that will be included in all medical encyclopedias and textbooks in the world: “War is a traumatic epidemic. Just as during large epidemics there is always a shortage of doctors, so during large wars there is always a shortage of them.” . He was convinced in practice that in such a situation, in the interests of the wounded and sick, it is necessary to expand the functions of the nurse; they should be broader than those of the nurse, and the quality of medical care should be higher. And preventive measures to prevent diseases, especially infectious ones, to create conditions for recovery turned out to be so striking that, as N.A. Semashko noted, N.I. Pirogov proved that “the future belongs to preventive medicine.” This was also proven by the sisters of mercy who worked under the leadership of N.I. Pirogov in the most difficult conditions of the Crimean War.

N.I. Pirogov introduced the concept of specialization in the work of community nurses: “housewives”, “pharmacists”, dressing and operating nurses appeared, the concept of “head nurse” appeared instead of the position of “chief supervisor”. Pirogov N.I. defended the idea of ​​​​introducing female labor in hospitals (before this, care was provided to a greater extent by men).

On November 5, 1854, 38 nurses, led by Miss Florence Nightingale, arrived from England at the location of the allied armies in Constantinople; at that time, according to various sources, there were up to 3,000 wounded in English hospitals. Nurse nurses were stationed in a barracks hospital (in Scutari, Turkey) and performed various jobs depending on need and skill: some of them helped surgeons, others worked as cooks, laundresses, seamstresses, and still others prepared pillows and mattresses.

F. Nightingale went to the scene of hostilities, in Balaklava, only in the early summer of 1855 with the aim of visiting hospitals to which she had previously sent some sisters. Miss Nightingale not only donated her savings to the establishment of a coffee shop in Inkerman, but also helped in the establishment of reading rooms, organizing readings for sailors, also wrote letters for soldiers, made sure that their remittances were sent to their homeland, and was involved in the establishment of baths, laundries, and sick leaves. kitchens, which helped reduce mortality and sanitary losses in the English army. At the end of 1855, F. Nightingale returned to England and organized a collection of donations with the aim of creating a school for training sisters of mercy. On June 26, 1860, she opened the world's first school for training sisters of mercy in London at St. Thomas's Hospital.

FLORENCE NIGHTINGALE'S COMMITMENT

I, solemnly before God and in the presence of this assembly, pledge:

To spend my life in purity and serve my profession faithfully. I will abstain from everything that causes harm and death and will not take or knowingly give harmful medicine. I will do everything in my power to support and elevate the standard of my profession, and I also promise to keep confidential all personal matters within my care and the family circumstances of patients that come to my knowledge during the course of my practice.

With fidelity, I will strive to assist the physician in his work and devote myself to the welfare of those who have entrusted themselves to my care.

In her “Notes on Nursing,” F. Nightingale defined nursing, showed its difference from medicine, and she created a model of nursing, i.e., a theory that was taught in the first nursing schools in Europe and America.

The name F. Nightingale became a symbol of mercy.

Every 2 years, the International Committee of the Red Cross awards 50 medals in her name on her birthday (May 12). This is the highest award for nurses and Red Cross activists. The regulations about this medal say that it is given “not to crown a career, but to mark outstanding actions and recognize exclusively the moral qualities of the recipients.” Currently, about 1,000 people have this medal.

Thus, in the domestic literature devoted to the Crimean War and its medical support, it is emphasized that the Holy Cross community is deservedly the first medical formation in the world; its activities were carried out according to a clear system proposed by the brilliant surgeon N. I. Pirogov. In fact, on the battlefields of the Crimean War, the basic principles of military field surgery were born, a well-thought-out system of staged treatment and evacuation of the wounded, later formulated by N. I. Pirogov in “The Beginnings of General Military Field Surgery” (M; Leningrad, 1944) .

Russian Red Cross Society

in wars and natural disasters of the late XIX - first half of the XX century

Helping the wounded by the sisters of mercy was a prerequisite for the organization of the Red Cross Society. Its founder, Swiss citizen Henri Dunant, wrote that the idea of ​​visiting battlefields and organizing international, private and voluntary assistance to war victims, without distinction of their rank or nationality, appeared to him partly under the influence of the activities of Princess Elena Pavlovna during the Crimean War , N.N. Pirogov and the sisters of the Holy Cross community.

July 25 - 27, 1859 A. Dunant witnessed the Battle of Solferino in Italy between the troops of Napoleon III and the Austrian army. Europe has not seen such bloody battles since the Battle of Waterloo. After the battle, 23 thousand wounded remained on the battlefield, to whom no one provided medical care.

Dunant outlined his impressions of the consequences of the battle in the book “Memoirs of the Battle of Solferino,” copies of which he sent to the leaders of European states. Subsequently, the book was translated into many languages. He wrote: “If there were international aid unions, if there were volunteer orderlies... then how much invaluable good they could do; how many wounded could be picked up on the battlefield in a timely manner and saved; if there were means of transportation, it would be possible it would be possible to operate earlier... For this, orderlies are needed, voluntary orderlies, active, trained, trained and called by commanders for this activity. Military personnel are insufficient for this and will never be sufficient, even if it is doubled or tripled.

It is imperative to appeal to the people, for only with their assistance can we hope to achieve beneficial results. We must make an appeal in all countries to everyone, no matter what class and social position he may be, both men and women, the princess and the poor widow, everyone who still has a heart full of love for their neighbor. It is necessary to put forward an international principle, consecrate it with a national agreement and, to implement it, organize unions in all European countries to provide assistance to the wounded."

In August 1863 in Berlin, at the International Congress of Statistics (at the section on comparative statistics and the state of health and death among soldiers and the common population), the reports of Dunant and the Dutch physician Basting on the organization of voluntary sanitary detachments in all countries were approved.

In October of the same year, an International Conference opened in Geneva, in which representatives of 14 countries took part. Here a resolution was passed which stated that each country should have a committee which, in the event of war, should organize assistance to the sanitary services of the armed forces. The International Committee for Assistance to the Wounded was also created.

On August 22, 1864, in Geneva, representatives of 16 states already concluded an international treaty on assistance to the wounded during wars - the Geneva Convention. Later, 26 more countries, including Russia, joined this agreement. The distinctive sign of the organization was the coat of arms of Geneva as the center of spiritual unity of the participating countries: a red cross on a white flag.

1866 was a new stage in the development of female nursing care in Russia. On the initiative of life surgeon I. A. Neranovich and doctor F. Ya. Karel, steps were taken to create the Red Cross Society. On May 3, 1867, the State Council approved the charter of the society, which received the name "Russian Society for the Care of Sick and Wounded Soldiers." In 1879 it was renamed the Russian Red Cross Society.

The society assumed the functions of training experienced medical personnel for wartime needs, organizing hospitals at the front, collecting donations and providing material assistance to the wounded and sick. Many outstanding physicians actively participated in its activities at different stages - N. I. Pirogov, N. V. Sklifosovsky, S. P. Botkin, S. I. Spasokukotsky, N. A. Velyaminov, N. N. Burdenko and others .

The Russian Red Cross Society of the late 20th century was a closed organization. It was headed by the Main Directorate in St. Petersburg, and district directorates were created locally, located on the territory of military districts; in provincial towns there were local administrations and in district towns there were committees. There were 109 Red Cross communities in total. All newly opened communities of nurses were under the jurisdiction of the Red Cross Society.

The first Red Cross community was established in 1868 in Moscow. The process of creating communities of sisters of mercy by the Red Cross Society was slow. During the period from 1871 to 1881, mainly in connection with the wars, 11 communities were opened, of which the most famous were Elisavetinskaya in Warsaw, Mariinsky in Kyiv and Irkutsk, Kasperovskaya in Odessa, Aleksandrovskaya in St. Petersburg. The growth of the number of communities and famine in the country in 1891-1892 slowed down. Unmarried women or widows between the ages of 20 and 40 could become sisters of mercy. The number of sisters in the community was established depending on the needs of their medical institutions and ranged from 40 to 80. The probationary period for students was set to one and a half years. The students and sisters were fully supported by the community: they received housing, food, clothing, and pocket money (10 rubles) here. Red Cross communities had their own homes for elderly sisters, and those who served for 25 years were given a pension of 200 rubles.

The sisters of mercy schools that existed in the communities had a two-year, and some - a year and a half course of study. The school program included the following subjects: 1) anatomy and physiology - 30-40 hours; 2) hygiene - 20 hours; 3) general and private pathology - 42 hours; 4) general nursing - 30 hours; 5) general surgery - 10 hours; - 24 hours; 9) desmurgy and the doctrine of asepsis - 24 hours; 10) care of surgical patients - 11 hours; 12) eye diseases - 12 hours; 24 hours and 14) theology.

The First World War caused an explosion of patriotism in Russia. Zemstvo and city self-government bodies took upon themselves the responsibility to help serve the various needs of the army, including sanitary ones. However, in general, the military medical service of the Russian army was unable to provide the organization of medical care and the evacuation of the wounded and sick - there were not enough personnel, property, and medical institutions. By 1912, there were only 3,442 nurses in 109 communities, and tens of thousands were needed. As in the Russian-Japanese War, mass training of nurses began in short-term two-month courses. At the end of 1914 in Russia there were already 150 schools in the communities of the Red Cross Society, where more than 10 thousand students studied. Practical classes with nurses were conducted in 80 hospitals, 12 outpatient clinics and 10 pharmacies of the Russian Red Cross Society.

The social composition of those studying at the nurses' courses was very diverse - students of higher women's educational medical and non-medical institutions, women from the working environment, of noble origin, and even women from the Romanov family. In specialized and fiction literature after the 1917 revolution, it was not customary to objectively reflect the activities of the latter in the field of helping the wounded. And many of the secular ladies were not limited to guardianship and allocation of funds. So, when the war began, Empress Alexandra Feodorovna, together with her eldest daughters Olga and Tatiana, enrolled in short-term training courses in caring for the wounded. As sisters of mercy, they worked daily in the Tsarskoye Selo infirmary. In the surviving diaries of Grand Duchess Olga Nikolaevna, in letters from her sisters and mother, work in the infirmary is constantly mentioned, which aroused their interest and compassion for people. The Empress told her husband that working in the infirmary was a consolation for her. She wrote about the bandages she made, about the condition of the wounded under her care, about the death of those to whom she had become attached and whom she had grown to love.

The younger sister of Nicholas II, Grand Duchess Olga Alexandrovna, was a rare phenomenon. Dressed as a simple nurse, she occupied a modest room with another sister, began working at 7 o’clock in the morning and often did not sleep for several nights in a row if it was necessary to bandage the newly arrived wounded. Even the wounded had difficulty believing that the sister who looked after them so tenderly and patiently was the daughter of Alexander III.

Alexandra Lvovna, the youngest daughter of L.N. Tolstoy, was also a sister of mercy at the front and led a sanitary detachment during the First World War.

On December 27, 1919, by a joint order of the Revolutionary Military Council and the People's Commissariat of Health, the provisions “On the courses of red sisters (assistants of sisters of mercy)” and “On the courses of red nurses” were approved. The regulation “On the Courses of the Red Sisters” stated that “in order to create sisters of mercy close in conviction and spirit to the Red Army, who could replace the sick and wounded Red Guard of the former sisters of mercy, alleviating his suffering, and at the same time politically enlighten him In the spirit of communist construction of life, two-month courses for red sisters (assistants of sisters of mercy) are being established at the District Military Sanitary Directorates." Communists and their sympathizers from among the workers, who had a recommendation from party bodies, were accepted to the courses. After completing two months of training, passing exams and receiving a certificate, the sisters were sent to the front. In terms of their rights, the red sisters were equal to the sisters of mercy in medical institutions of the Military Department. In 1920 alone, 2,442 nurses and 1,923 nurses were trained.

Red nurses trained for 4 weeks and after passing tests in anatomy, physiology, hygiene, infectious diseases, disinfection and disinfestation, surgery and practical skills, they received a certificate, the title of red nurse and were also sent to the front.

During the Civil War, 66 thousand women served in the Red Army, including 10 thousand sisters of mercy. They made up 2% of all military personnel and worked selflessly in hospitals, ambulance trains, medical centers, and bath and laundry units.

The sanitary and epidemic situation was extremely dangerous on the fronts of the civil war. The incidence of typhoid, typhus and relapsing fever and cholera per 10,000 population increased from 31.5 cases in 1918 to 370.3 in 1919 and to 411.2 cases in 1920. Only from October 1918 to October In 1920, 1,354,752 people suffered from typhus and relapsing fever.

The problem of combating epidemics in the rear and at the front has acquired enormous national importance. The entire public was mobilized to fight epidemics, emergency sanitary commissions, epidemiological squads, hospitals, sanitary educational cells, and special squads were organized to carry out vaccinations against smallpox, typhoid fever and cholera. More than 400 medical and sanitary institutions of the Red Cross Society worked at the front and in the front-line zone, including 24 anti-tuberculosis institutions, 60 venereal disease units, 16 eye departments, and a large number of anti-malaria units. Sisters of mercy also worked in all these structures.

After the Civil War, many nurses of the Red Cross Society took part in the fight against hunger. Medical and nutritional teams were sent in large numbers to the Volga, Kyrgyzstan, Siberia and Turkestan, and using funds raised in the country and abroad, they fed and provided medical care to more than 120 thousand people every day. When eliminating the consequences of the famine in 1922-1923. The Soviet Red Cross carried out work in two directions: the society's institutions continued to provide medical and nutritional assistance to children - the part of the population most affected by hunger; In the areas most affected by famine, rural outpatient pharmacies were organized for the first time.

In 1922, the year the USSR was founded, the Red Cross Society was reorganized into the Union of Red Cross and Red Crescent Societies (SOKK and KP).

In 1924, when famine engulfed a number of central provinces of the RSFSR, the North Caucasus and Crimea, the Red Cross Society again came to the rescue, providing medical care to more than 5 million residents of these territories.

During this period, the Red Cross Society - as a public organization - used its capabilities where practical health authorities could not manage with their own funds. The activities of 179 (mainly tuberculosis and dermatovenerological dispensaries) out of 757 medical institutions of the Red Cross Society were aimed at combating social diseases. There were 68 institutions for the protection of motherhood and childhood belonging to the Red Cross Society.

On June 6, 1925, by resolution of the All-Russian Central Executive Committee and the Council of People's Commissars of the RSFSR, a new “Regulation on the Red Cross Society” was approved, according to which Red Cross institutions should create schools and courses for the training of medical workers. In 1926, nurses began to be called nurses, in 1927 the first sanitary squads were created, and starting from 1928, systematic training of nurses began.

During this period, the executive committee of the Union of Red Cross and Red Crescent Societies organized “courses for reserve nurses.” Training in these courses was conducted free of charge, and those who completed them received a certificate giving the right to perform the duties of nurses in wartime. In 1934, the first “Manual for courses for reserve nurses” was published.

During the military conflicts between Russia and Japan - at Lake Khasan (1938), on the Khalkhin Gol River (1939), as well as during the war with Finland (1939-1940), nurses showed heroism and courage when performing their professional duties.

During the Great Patriotic War, the need for nurses for the needs of the front and rear increased sharply, so the People's Commissariat of Health of the USSR took measures to accelerate the training of specialists with secondary medical education. In the first 6 months of the war alone, the Red Cross Society trained 106 thousand nurses and 100 thousand sanitary workers. And during the entire period of the war, Red Cross organizations trained more than 280 thousand nurses, about 500 thousand sanitaries and 36 thousand nurses.

It should be noted that it was medical workers with secondary specialized education (nurses, midwives, paramedics, pharmacists, etc.) who ensured the implementation of basic anti-epidemic and therapeutic measures in the rear and in the territories of the country liberated from the fascist invaders.

In the ranks of the Soviet Army, 200 thousand doctors, 300 thousand nurses and more than 500 thousand sanitary workers walked the roads of war. Under enemy fire, risking their lives, they provided assistance to the wounded and carried them out of the battlefield. Typical in this regard is the fate of the nurse of the Marine Corps battalion, Ekaterina Demina. By the beginning of the war, she was a pupil of an orphanage and had no medical education. In June 1941, she went to Brest to visit her brother, and the train she was on was bombed on June 22 near Orsha. There were many wounded. E.I. Demina, together with other girls, provided them with medical care. She herself was wounded and ended up in the hospital. After recovery, she completed short-term nursing courses and was sent to a Marine battalion. The girl participated in all landing operations of the battalion, in the liberation of Hungary, Austria and Yugoslavia from the Nazis. The brave nurse saved the lives of 150 wounded, destroyed 59 fascists, and was wounded three times. E.I. Demina was awarded two Orders of the Red Banner. After the war, she graduated from medical school and worked as a doctor in Moscow and the Moscow region for many years.

Many nurses were drafted into the active army. At the front, they worked as sanitary instructors for companies, in regimental and divisional medical centers and hospitals. Here, nurses showed exceptional cordiality towards the wounded and sick, a willingness to give all their strength and even their lives in the performance of their duties.

The fates and exploits of many sisters are similar. All of them, on the battlefields and in days of peace, without sparing themselves, sought to alleviate human suffering; the main thing in their lives was philanthropy. By 1995, the International Committee of the Red Cross had awarded 46 women in our country the Florence Nightingale Medal. This medal recognizes nurses for exceptional dedication and bravery in caring for the wounded and sick in both war and peace.

For the first time, the Soviet Red Cross nominated candidates for the F. Nightingale medal in 1961. Then the medal was awarded to two participants in the Great Patriotic War: a guard lieutenant colonel of tank forces, a writer, Hero of the Soviet Union, Muscovite Irina Nikolaevna Levchenko and a surgical nurse, the chairman of the primary organization of the Red Cross at the Leningrad factory "Skorokhod" of Lydia Filippovna Savchenko. In 1965, this medal was awarded to a nurse, Hero of the Soviet Union, Zinaida Mikhailovna Tusnalobova-Marchenko. And then every 2 years, from 3 to 6 Soviet women received medals.

In 1975, Vera Ivanovna Ivanova-Shchekina, a timber mill worker and former sanitation worker, was also awarded the Florence Nightingale Medal. On the very first day of the war, seventeen-year-old Vera Shchekina came to the military registration and enlistment office with a request to send her to the front and heard: “We need sergeants, you will go to study courses.” And when Vera finished the course, the military registration and enlistment office said: “The front is now here, in Leningrad.” And the young sanitary began to work in the hospital. She gave all her strength and skill, tenderness, care and attention to the fighters to ease their suffering. And in September 1941, Vera Shchekina was appointed commander of the sanitary squad and was tasked with inspecting the apartments of residents in her microdistrict. The duties of the sanitary workers included identifying the sick and weakened and delivering them to the hospital. One day, while walking around a destroyed house, she saw a woman lying, came closer, felt her pulse - she was dead. Vera was about to move on when she suddenly noticed something moving under the woman. Child! His mother deliberately shielded him from the fragments! Vera took the girl to the children's reception center. Receiving the child, the nanny asked: “What is your name?” The girl answered: “Marinka.” The rescued girl did not know her last name. The nanny, after thinking, said: “You will be Shchekina.”

It was normal duty. Vera Shchekina walked, carefully looking around. An old man stopped at a large gray house. I leaned against the wall - there was no strength to move on. The girl came up to him, took his arm and helped him walk to the apartment. I went outside and saw a child lying on the pavement. I started to bother him - he was alive! I gained more strength from joy. More likely to the children's reception center. There they asked her: “What is the girl’s name?” Vera didn't know. The attendant said: “That means there will be Vera, and Shchekina again. We give all nameless children your first and last name, and if it’s a boy, your father’s first and last name.”

During the years of the blockade, together with her friends, she helped almost 500 people in need. More than 50 children she rescued from empty apartments and destroyed buildings were handed over to children's foster homes alone.

Valeria Gnarovskaya, a resident of the Leningrad region, in 1942 at the age of 18, achieved voluntary sending to the front and served as a medical instructor. During the fighting, she saved the lives of more than 300 wounded privates and officers, providing them with timely medical assistance. In one battle alone, she carried 47 wounded from the battlefield along with their weapons. On September 23, 1943, German Tiger tanks broke through the defenses of the Soviet troops, went in the direction of the unit where Gnarovskaya served, and approached the regimental headquarters and a group of wounded who were awaiting evacuation. When the tanks were 50-60 meters from the wounded and the regimental headquarters, Valeria grabbed a bunch of grenades, rose to her full height and threw herself under the tracks of an enemy tank. There was an explosion and the "tiger" was destroyed. The second tank was hit by an anti-tank rifle, the rest turned back. The enemy attack was repulsed and the wounded were rescued. Gnarovskaya was awarded the title of Hero of the Soviet Union.

Many orderlies and medical instructors were awarded the highest soldier's award - the Order of Glory, which was awarded only to privates and sergeants. Orders of Glory of all three degrees were awarded to 18 medical workers and among them one woman, medical instructor Matryona Semenovna Nechiporchukova-Nozdracheva. The chronology of her exploits is as follows. In August 1944, during 2 days of fighting, she provided assistance to 26 wounded; under enemy fire, risking her life, she carried a wounded officer to a safe place and evacuated him to the rear. For these exploits she was awarded the Order of Glory, III degree. Matryona Semyonovna was awarded the Order of Glory, II degree, for saving the lives of the wounded in the winter of 1945. For two days she guarded more than 30 wounded, fed and watered them, bandaged them, and only on the third day evacuated them to the hospital. On April 24, 1945, M. S. Nechiporchukova-Nozdracheva was awarded the Order of Glory, 1st degree, for the fearlessness she showed on the battlefield when rescuing 78 wounded soldiers and officers under enemy fire. During the battles for Berlin, acting directly in the ranks of the attackers, she provided assistance to the wounded.

When crossing the Spree River in Berlin, she and the soldiers crossed the assault bridge to the other side and provided assistance to the wounded under fire. Even after being wounded, she continued to do her duty.

The experience of the Great Patriotic War, as well as the Crimean War, once again showed that nurses performed a number of medical functions in the interests of the sick and wounded. They have proven that they can work independently, especially when carrying out preventive, anti-epidemic and rehabilitation measures. Nurses were closer to the sick and wounded; they were more often on the battlefield. Therefore, it is no coincidence that among the medical workers awarded the highest government award - the title of Hero of the Soviet Union, there were more nurses than doctors.

The state of the compassionate sisterhood movement in Russia at

modern stage (end of XX - beginning of XXI century)

After the October Revolution of 1917, the tasks of training paramedical personnel were solved in accordance with the healthcare needs of Russia and its economic condition. The consequences of the First World War, two revolutions of 1917 and the civil war - hunger, infections, high infant and maternal mortality, homelessness of children, the state of public health - required urgent measures to organize and provide every citizen of the country with qualified and accessible medical and preventive care . It was necessary not only to train more nurses, paramedics and midwives, but also to make changes to curricula and programs to solve existing problems in protecting health and providing medical care to the population. Therefore, it is no coincidence that in February 1919, by order of the People's Commissariat of Health and the Russian Red Cross Society (nursing schools, as before 1917, were under its jurisdiction), the regulations on nursing schools were approved, as well as curricula and programs designed for 3 years of study. Given the great need for these specialists, persons with primary (2nd grade) education were also accepted for training.

By the beginning of 1925, the following types of secondary medical educational institutions had been formed in the country.

1. Medical assistant and midwifery schools with a duration of study of 4 years. They accepted people who had completed 4th grade. There were 10 such schools in Russia.

2. Paramedic and midwife schools, in which specialists were trained for 2.5 years. To enter these educational institutions it was necessary to complete a seven-year school.

3. Schools for training nurses to care for the sick (later renamed into nursing courses) with a training period of 2 years. The school accepted people with a 4-year education.

4. Technical colleges, schools and courses with various periods of study for nurse educators, sisters for the protection of motherhood and infancy.

5. Preventive technical schools, the duration of training in which was 4 years.

6. Evening schools of nurses with a duration of study of 3 years.

7. Two-year courses for sanitary assistants.

8. Retraining courses for military (company) paramedics to work in schools; Duration of training: 3 years.

9. Courses for disinfectants with a training period of 6 months.

10. Training courses for massage therapists. Duration of training - 1 year.

In 1926 in Moscow, at the II All-Russian Conference on Secondary Medical Education, successes and shortcomings in the system of secondary medical education were discussed, and ways of its development were determined. The conference participants noted that the existing system of secondary medical education does not provide the appropriate level of training for medical workers. It should be noted that the new curricula, as amended in 1919, provided for the training of nurses who possessed well-developed technical skills and were physician assistants. It was proposed to replace the term "nurse" with the terms "doctor" or "deputy doctor", which seemed more consistent with its purpose. Supporters of this idea considered the definitions of “sister” and “sister of mercy” to be monastic and limited, not corresponding to the new type of medical worker in Soviet health care. The unified system of secondary medical education was created in 1936 and was subordinate to the People's Commissariat of Health of the USSR. Its objectives were determined by the Government Decree “On the training of secondary medical, dental and pharmaceutical personnel” (1936). The resolution provided for an increase in the number of secondary medical schools. Medical colleges were again reorganized into medical schools for the training of paramedics, nurses, pharmacists, dentists, as well as midwifery schools and courses for medical laboratory assistants and dental technicians. The reason for the reorganization of the secondary medical education system was the intensive construction of new hospitals and clinics, the development of a network of treatment, preventive and sanitary institutions in the city and in the countryside, and further specialization of medical care. Thus, by 1940, the number of hospital beds in the country exceeded 790 thousand compared to 208 thousand in the pre-revolutionary years. At the same time, the provision of the population with specialists with secondary medical education increased and reached 24 per 10 thousand inhabitants, which was 8 times higher than the pre-revolutionary level and almost three times the same indicators in 1928. After the Great Patriotic War, important measures were taken in the country to improving health care for the population. First of all, institutions for the protection of motherhood and childhood were restored; construction of maternity hospitals, antenatal clinics and children's clinics has been launched; the network of rest houses and sanatoriums has been restored; medical and social assistance to disabled people and orphans was organized. In this regard, the country's practical healthcare need for qualified paramedical workers has increased. In 1946, the USSR Ministry of Health approved new curricula, which provided for deeper teaching of theoretical disciplines and improved practical training for medical school graduates. In 1953, in accordance with the decision of the USSR Ministry of Health, medical schools were reorganized into medical schools and their multidisciplinary nature was eliminated. The terms of study were determined depending on the general educational preparation of applicants (8th or 10th grade of education). In 1963, the question of the feasibility of opening medical schools at large multidisciplinary hospitals, which are also the clinical bases of higher medical educational institutions and research institutes of the country, was finally resolved. This made it possible to bring the training of nurses closer to their place of future work. In the same year, advanced training courses for paramedical workers began to be created at large medical institutions. The socio-economic reforms that began in the country in the late 80s required a reorganization of the system of providing medical care to the population. The training system, the definition of the functional responsibilities of a nurse, and the development of quality standards for her work should be determined by the WHO provision that nursing is an independent discipline. Nursing care is considered as an organized multifaceted process aimed at the individual, with his physical and psychosocial problems. This approach to nursing, adopted in developed countries of the world, also requires the training of specialists of a special level - nurses with higher education. Despite different economic conditions, different political systems, cultures and languages, there are universal factors that influence the development of nursing in every country. Among them, there are three main ones: the predominance of women among nursing professionals; the predominance of the role of curative medicine over preventive medicine; lack of representation of nurses in legislative and executive bodies. On November 5, 1997, a government decree approved the “Concept for the development of healthcare and medical science in the Russian Federation,” according to which the development of primary health care (PHC) is one of the main directions in improving the organization of medical care. Today, healthcare needs a nurse who is not only a good performer of professional duties, but also a creative person who would take into account the psychological characteristics of the patient and even the home environment and family relationships. And today the population is in great need of medical knowledge and does not want to limit itself to just calling an ambulance. Unfortunately, for several decades in Russia, nursing issues have not received due attention. The development of nursing technologies, taking into account modern science in developed countries, has led to a sharp lag in nursing in Russia. The prerequisites for the reform of nursing and its development are: negative medical and demographic processes, especially the decline in the birth rate and the aging of the population, the deterioration of the health of the population, the chronicization of pathological processes in the body, the spread of new diseases such as HIV, and the increase in the cost of medical services. The provision of medical institutions with nursing staff is gradually decreasing. The two-stage method of serving patients (doctor, nurse) led to a decrease in the professional competence of nurses and the performance of functions that were not typical for them. The supply of medicines, care items, and instruments to L1GU is decreasing. The imbalance in the ratio between doctors and nurses is increasing, and as a result, the quality of care provided has deteriorated. Nursing reform in our country began in 1993. At the international conference "New Sisters for a New Russia", a philosophy of nursing was adopted, which marked the beginning of this process. By 1994, a multi-level system of nursing education (school, college, VSO) had been formed in Russia. The first graduation of specialists with higher nursing education took place in 1995. By 2002, the number of Russian universities in which faculties of higher nursing education were opened was 34, and the total number of graduates was over 2.5 thousand managers in the field of nursing. Leader of nursing, initiator of the creation of the Faculty of Higher Nursing Education at the Moscow Medical Academy named after. THEM. Sechenov is G.M. Perfilyeva, professor, dean of the faculty of higher nursing education. Currently, completely new periodicals are being published in the Russian Federation for teachers of educational medical institutions, practitioners, nurses, paramedics, midwives, organizers and other healthcare workers. The main ones are: the scientific and practical journal "Medical Help", which has been published since 1993; in 1995, the magazine "Nursing" was published; The magazine "Nurse" has been published since 1999. , editor-in-chief of the journal - Professor Perfilyeva G.M.; "Sister of Mercy", published since 2001.

When people talk about the history of medicine, they often remember the names of great doctors: Hippocrates, Galen, Ibn Sina, Pirogov, Botkin, Sklifosovsky, Bekhterev, Ilizarov and many others, as well as the history of the development of diagnostics, pharmacology, deontology and other components of healing. At the same time, they completely forget about the role of nurses, paramedics, and midwives.
When and how did nursing appear as a concept and as a practice of caring for patients? Familiarization with a number of historical and medical works by domestic and foreign authors allowed us to conclude that nursing is older than medicine and civilization. These are materials of a paleopathological nature, discovered during archaeological excavations and indicating that people of the Mousterian period (about 100 thousand years BC) survived after fractures, wounds, and ritual trepanations thanks to nursing.
As a specialty, nursing was formed in the middle of the 19th century, almost simultaneously in Russia and the West, and by the end of the 20th century. flourished in the USA and other countries. In Russia, it appeared as one of the lowest paid and most unprestigious professions.
Attempts to understand the reasons that gave rise to the current situation and hinder the way out of it lead us to the need to trace the history of the development of nursing in the world in general, and in Russia in particular.
What does history give us? It allows us to learn about the events of the past, helps to identify the connection between distant events and our lives. History gives us a sense of belonging and provides the opportunity to discover our roots in those civilizations and peoples that no longer exist. It gives us a chance to avoid mistakes by learning from the past.
Getting to know the history of the development of nursing turns us to the roots of this unique profession, introduces us to the factors that influenced and influence development and establishment of nursing throughout the world and in our country.
The study of history is intended to recreate what has been forgotten, to recall what has survived and call for its preservation, to pay tribute to those who, to the best of their ability and ability in accordance with the spirit of the time, did good deeds in the name of love for people. Discovering the events of the distant past, we discover the names of a whole galaxy of philanthropists. Representatives of various classes gave to those in need what they had: some - fortune, others - strength and time. These were people who received satisfaction from the consciousness of their own benefit and service to their fatherland. They left us monuments of kindness and mercy. Our task is to remember and preserve them.

On the development of nursing abroad

Approximately the first five centuries AD. Nursing care consisted mainly of performing hygienic measures and creating comfortable conditions for the needy, homeless and sick. It was provided mainly by early Christians, both individually and within the framework of the Christian Church. In ancient Rome, for a long time, anyone could even treat the sick. But, as a rule, this occupation, “despicable” from the point of view of the patricians, was the lot of slaves of Greek or Jewish origin.
In subsequent centuries, as Christianity established itself as the dominant religion in Europe, the Church took upon itself the care of the weak and sick. This responsibility rested with deacons and deaconesses. Even entire orders of knighthood appeared, devoting themselves entirely to care.
In 1633 in Paris St. Vincent de Paul and St. Louise de Marillac founded the Daughters of Charity congregation. It was the first open religious women's organization that was involved in charity work. Her activities, initially aimed at caring for the poor at home, eventually began to include teaching poor children, working in hospitals, and caring for the wounded. By the beginning of the 21st century. this congregation grew into the largest religious women's organization in the world.
All these people who helped children, the weak and the sick, these knights on the battlefield, monks and deaconesses stood at the origins of nursing, which turned into a profession as a result of long-term efforts to meet the needs of society.
Nursing thus originated within the traditional model of human care. The honor of creating it as a profession belongs to the English sister Florence Nightingale (1820-1910). F. Nightingale was an extraordinary person, as evidenced by her biography.
She was born on May 12, 1820 in Florence, where her parents temporarily lived. She owed her education mostly to her father, who taught her Greek, Latin, French, German, Italian, history, philosophy, and mathematics. On February 7, 1837, she “heard a voice” about her special mission, but only nine years later did she understand what it was. F. Nightingale wanted to study the organization of patient care directly in hospitals, but she was not allowed. Then she began collecting information from official documents, and within three years, influential friends began to consider her an expert in health care. In 1846 they sent her the “Yearbook of the German Protestant Organization of Deaconesses.” This organization operated a school that trained girls of good character to care for the sick. Florence entered it at the age of thirty and completed the full course of study.
The hospitals of that time, which mainly treated the homeless and the poor, employed only women of questionable behavior who were not hired for any other work. Wealthy patients were cared for at home by family members and servants.
In addition to hospitals, care facilities for wealthy people began to appear. In 1853-1854. in London, F. Nightingale worked as the head of a similar institution for the care of sick noble women. She called her institution a “little wormhole” and yearned for broader activities. The Nightingale family had a negative attitude towards these activities of Florence.
When the Crimean War (1853-1856) broke out and allied British and French armies landed in the Crimea, the British were particularly alarmed by the state of affairs in the army related to the state of care for the wounded. Florence immediately decided to volunteer, taking with her a small detachment of sisters. On November 5 they arrived at the site; there were no conditions for treatment or care there. One pint of water per day was allocated for all needs. The doctors were initially hostile, and nurses were not allowed in the wards. It wasn't just the doctors who were against it. One of the European newspapers of that time wrote that Nightingale and her associates ignored the social laws of decency and began to help the suffering, while directing their activities not to helping people of the same sex, but mainly to caring for wounded soldiers. But the situation soon changed: thanks to care, the mortality rate among the wounded dropped from 50 to 2%.
Nightingale had great powers. Using the money she brought with her, she organized the provision of the hospital with everything necessary, and also dealt with administrative issues and correspondence. By the end of the war, Florence became the leader of all nursing units that worked in British hospitals in the Crimea. Florence Nightingale returned to England as a national hero.
Upon returning home, she decided to direct her activism towards improving the living conditions of British soldiers. As a result, in May 1857, a meeting of the commission on health problems in the army was held, at which Nightingale made a report. As a result of the work of the commission, the Army Medical School was created in the same year.
The Indian popular uprising (1857-1859) against the British colonialists also attracted the attention of F. Nightingale. Another royal commission was appointed, the result of which was the creation in 1868 of the Department of Health in the Ministry of Indian Affairs. Nightingale had never been to India, but at the same time she was considered a recognized expert on this country. Even government officials consulted her.
During her long life, F. Nightingale wrote about 150 books and monographs. The most significant work, which has not lost its relevance today, remains her small work “Notes on Nursing: What it is and What it is not”, 1860, where the main attention is paid to the issues of full-fledged nursing. Nightingale believes that the goal of care is to create optimal conditions for the patient's recovery. For the first time, such an area of ​​nursing as caring for the healthy has been highlighted. Drawing public interest in the environment as a set of external and internal factors affecting health, Nightingale draws attention to the need to change it.
In the 19th century The work of a nurse was not considered something so complex that it required special training. Although even then there were schools of sisters in the communities. For example, the school in Kaiserswerth (Germany), from which Nightingale brilliantly graduated in the early 50s. Florence emphasized that nursing, as a profession, is inherently different from medical practice and requires special knowledge, different from medical knowledge, and that the management of hospitals should be undertaken by specially trained nurses.
Nightingale convinced the public that a nurse often plays a decisive role in saving a person’s life, and therefore must have special knowledge and skills. On June 24, 1860, with the money raised in honor of the anniversary of F. Nightingale’s work in Crimea, the world’s first secular School for nurses was opened at St. Thomas’s Hospital in England. Miss Nightingale designed for
This school has a detailed training plan, a daily routine for students (of whom there were ten at first) and rules of behavior. She believed that the training of nurses should be carried out by specially trained sisters (it should be noted that among doctors, the establishment of a school of nurses was met with hostility). Over the following years, not without her active role, many schools were opened to train midwives and nurses to work in hospitals for the poor. Thanks to Nightingale, the education of sisters ceased to be a monopoly of the church.
From 1857 Florence lived mainly in London. The illness confined her to bed. Without rising from her couch, she received many visitors (who either passed on information to her or came for her), and carried on a huge correspondence (she wrote about 12,000 letters).
There is no information that Florence had any organic disease. Her illness was most likely neurotic in nature, perhaps with a dose of mystification. Nightingale worked day and night. Gradually her vision began to fail. In 1901 she became blind.
In 1907, King Edward VII awarded her Britain's highest honor, the Order of Merit. This is the first time a woman has been given this honor.
Florence Nightingale died in 1910. And in 1911, a monument to her was unveiled in London. At the opening ceremony, the mayor of London noted that the monument was erected to commemorate the highest merits of the great Englishwoman.
In 1872, nursing schools were opened in Philadelphia and Boston in the United States. Linda Richards, who graduated from Boston High School in 1873, became the first certified American sister. In 1874, Mack Training School was opened in Ontario (Canada). In 1879, Mary Eliza Mahoney became the first black woman to earn a nursing degree. The British Nursing Association was founded in 1887, and the American Nursing Association (ANA) in 1897.
In 1899, the International Council of Nurses (ICN) was created as the first professional organization for women. Today MSM is actually the largest and most authoritative international professional organization, including 127 states. President of the MSM in 1997-2001. There was a Danish sister, Kirsten Stalkhnet. In 2001, the English nurse Christina Hancock was elected president of the MSM, and in 2005, the Japanese nurse Hiroko Minami.

On the history of the development of nursing in Russia

The most complete analysis of the history of the development of nursing in Russia presented in the works of G.M. Perfileva and in the monograph “History of Nursing in Russia”. G.M. Perfilyeva believes that the formation of secular nursing took an original path, without the noticeable influence of European medicine. It is Russia that has priority in shaping the idea of ​​nursing care as a special form of medical activity that requires special theoretical training. As an example, she refers to the textbook of the Russian surgeon, chief physician of the Mariinsky Hospital for the Poor, Christopher von Oppel (1822). Almost half a century later, many of his ideas were reflected in the works of F. Nightingale. But international isolation deprived both Russian sisters of the opportunity to join international experience and foreign colleagues to get acquainted with our achievements.
Summarizing the history of the development of nursing in Russia in the 16th-20th centuries, we tried to trace its main milestones (Table 1-1). For analysis, we will conditionally highlight four stages of the development of nursing in Russia: pre-Petrine; 1701-1917; 1918-1976; from 1977 to the present day.

Pre-Petrine period of development of nursing

In Rus', court doctors appeared already in the 10th century. under the Kyiv princes. These were mainly monks of the Kiev-Pechersk Monastery. Hospital wards were created at the monasteries. The place where pain puts a person “prone” began to be called hospitals. One of the first mentions of a hospital hospital in Rus' is associated with the name of Princess Olga, who organized a hospital where women began to care for the sick. The monasteries taught the art of healing and medical culture to the daughters and widows of noble people. Hospital buildings, as a rule, were located outside the monastery walls, with laundries, baths, vegetable gardens, and cemeteries adjacent to them. The rich were obliged to take care of the comfortable existence of hospitals. During the days spent undergoing treatment in the hospital, the poor worked on arable land, in the fields, and as a carriage driver.

Table. Main milestones in the development of nursing in Russia in the 16th-20th centuries.

Before the Tatar invasion, the chronicles mention hospitals in Kyiv, Pereyaslavl South, Smolensk, Vyshgorod, Chernigov, Novgorod, Pskov, Volyn, Galician Rus, etc.
Characterizing the state of health care during the period of the Mongol-Tatar yoke, Russian medical historian N.P. Zagoskin wrote: “Laid out in the XII-XIII centuries. The beginnings of secular medicine are stalled in this era, ... medicine is completely withdrawn into monasteries...” But the rich traditions of traditional medicine were not lost, and handwritten works continued to spread. They gave advice on the use of medicinal herbs, food hygiene, and the use of baths. From the chronicle we know about Eupraxia, born in 1108, the granddaughter of Prince Vladimir, who deeply studied traditional medicine and left the first domestic medical work called “Ointments.” It is devoted to issues of physiology, hygiene, propaedeutics, and the prevention of certain diseases.
In 1551, at the Stoglavy Cathedral, the intention to open state hospitals and almshouses was first expressed, since monastery almshouses cannot “look after and treat everyone.” But, as we will see below, the first state hospital was opened in Moscow in 1707.
Thus, in Muscovite Rus', the participation of women in the fate of the sick was manifested in various types of charitable activities carried out by representatives of various classes.

Development of nursing in 1701-1917.

Development of nursing in the 18th century. For the first time, women began to be involved in caring for the sick under Peter I (1682-1725). For example, they had to serve in educational homes created “... for the preservation of shameful babies, whom wives and girls give birth to unlawfully.” However, the issue of “charity for foundlings” was resolved only under Catherine II, who opened educational homes in Moscow and St. Petersburg in the 60s of the 18th century.
In addition to the Military Regulations of 1716, Peter I defined the responsibilities of women in caring for the sick by the “Regulations on the Administration of the Admiralty and Shipyards”. In 1728, after the death of Peter I, staff positions for women were introduced into the hospital schedule.
In the “General Regulations on Hospitals” (1735) it is written: “Women should be employed in hospitals to wash the dresses and all linen of sick people. To supervise linen and female workers, have
each hospital has one matron and one assistant from old widows or good married wives who bear the praise of good fortune, and in this paragraph keep the mentioned workers in strong charity, so that not a single one of them could have similarities and talk with young single doctors and students, also with the sick or with the guard soldiers or with the guards, and be very careful that, besides those mentioned, other women (of whatever rank) do not enter the hospital.”
But the lack of a system for organizing women’s labor in hospitals and the lack of command interest in it led to the fact that in most hospitals, the participation of women in care either ceased over time or was temporary. As a result, the sick and wounded, especially in wartime, were practically completely self-sufficient. For example, in 1808, in the Grodno hospital there were 500 patients per doctor, with a complete absence of medical personnel.
As noted above, the initiatives of Peter I were destined to come true only during the reign of Catherine II (1762-1796). In 1763, the Pavlovsk Hospital was established in Moscow, in which the staff was supposed to have nursing soldiers, and for women - nursing women from the wives and widows of hospital soldiers. One of them was appointed “to examine sick women in hidden places of illness and insert enemas into them” and was called a babka, or clerister.
Later, women's labor began to be used in medical institutions of the military department. In the reports of the auditors appointed by the medical board for inspection for 1785, it was noted: “For cooking, for washing clothes and keeping the beds clean, there are a sufficient number of female soldiers at the hospital, and they are paid decently. These women are used to serve the sick, for whom, due to the types of illnesses, their care is decent.”
Based on the foregoing, we can conclude that in the 17th century. care in hospitals was provided by men (retired soldiers), “side-soldiers.” In the 18th century As part of the reforms carried out by Peter I, women began to be involved in caring for the sick in civilian and military medical institutions. At first these were old women from monasteries, then wives and widows of hospital soldiers. At that time, apparently, there was no special training for nurses to care for the sick.
Service of “compassionate widows”. Some authors believe that nursing in Russia arose in 1803, when the service of “compassionate widows” appeared. This year, Empress Maria Feodorovna is establishing “widows’ houses” in Moscow and St. Petersburg - shelters for poor widows left without a livelihood. The wonderful Russian writer A.I. spent his childhood in one of these houses. Kuprina. He described his childhood memories of the common ward of the “widow’s house” in the story “Holy Lies.”
In 1813, it was decided to recruit a number of widows from the St. Petersburg widow's home to assist in raising orphans and to work as nurses in the Mariinsky Hospital for the poor.
Mariinsky Hospital in St. Petersburg is the first private charitable medical institution. The hospital has 200 beds and an outpatient clinic, 9 doctors, 12 paramedics, 14 matrons, 60 attendants, and 54 other servants.
The hospital was completely self-sufficient. The income from the greenhouse, where vegetables and fruits were grown all year round, was enough to pay the salaries of all the staff, food for the sick and medicines.
Clean and warm wards, clean and dry bed and underwear, good nutrition, regular ventilation of the premises, annual whitewashing and painting of each ward and corridors, full care and treatment provided the Mariinsky Hospital with a reputation as one of the best hospitals in Europe at that time.
The Empress developed rules and instructions for staff (including doctors), almost daily personally supervised the treatment process, the work of the staff and the board of trustees, and ensured that patients were supplied with money, medicine and clothing after discharge.
At the beginning of 1814, 24 widows who expressed a desire to devote themselves to caring for the sick began their duties: every two weeks, eight widows moved to the hospital for duty. They observed the condition of the wards, the order in the distribution of food and medicine, the cleanliness and tidiness of the patients, their beds and linen, the behavior of patients and visitors. At the same time, women mastered some medical techniques in order to be able to provide assistance if necessary.
In March 1815, for the first time, 16 “compassionate widows” who had completed their probationary period were sworn in and presented with an insignia - the Golden Cross, which was ordered to be worn on
neck all my life, even if the “compassionate widow” retired. From the second year of service, “widows” could visit the sick in private homes, receiving payment for this. In 1819, a special verdict followed, establishing the Institute of Compassionate Widows. The ceremony of initiation and oath was carefully thought out by the empress herself. After completing the ritual, the dedicated widows received a certificate for the title of “compassionate”, which was published in the press.
With the establishment of the Institute of Compassionate Widows, the training of female medical personnel began. In terms of medical qualifications, compassionate widows occupied a middle position between a nurse and a nanny. Since 1850, widows' duty extended to the children's hospital. The existence of the service for compassionate widows was determined by the income of widows' homes and large donations from benefactors.
In 1818, a state service of nurses was created in Russia, who were trained in hospitals in sanitary and hygienic care for the sick and had full-time positions at hospitals. But in the first half of the 19th century. This form of training for medical personnel has not received proper development and has not made a significant contribution to patient care.
Thus, until the middle of the 19th century. The service of “compassionate widows” remained the only form of professional participation of women in caring for the sick. Christopher von Oppel, the chief physician of the Mariinsky Hospital in Moscow, in which compassionate widows from the Moscow widow's home served, published a textbook in 1822, which was called: “Guidelines and rules on how to care for the sick, for the benefit of everyone involved in this matter.” , and especially for compassionate widows who have especially dedicated themselves to this title.” The manual describes the principles of selecting nursing staff, the requirements for their physical and moral qualities, and the features of caring for the seriously ill, convalescent, wounded, infants, and the dying. Much attention is paid to the hygienic conditions of keeping patients, methods of performing manipulations, and rules for taking medications. The book is written clearly, thoughtfully, with great love and understanding of the importance of the work begun. It has not lost its relevance even today.
This textbook was used to train female medical personnel by doctors. This method of transmitting knowledge in our country has been preserved to this day, which, in our opinion, has its positive aspects (high intelligence of doctors, good theoretical and
practical training, knowledge of the peculiarities of a nurse’s work, her professional mistakes) and negative (the attitude of doctors towards the nurse with a certain shade of superiority, a view of the nurse’s problems only in the light of her role as an assistant).
“Compassionate widows” together with the sisters of mercy participated in the Crimean campaign of 1854-1856. Despite their noble origin (many were hereditary noblewomen), women performed the most difficult but necessary work. After the October Revolution, widows' houses were abolished, and their buildings were transferred to the People's Commissariat of Health. Since 1936, the building of the Moscow widow's house was occupied by the Central Order of Lenin Institute for Advanced Medical Studies (TSOLIUV), the administrative services of which are located there to this day (now the Russian Medical Academy of Postgraduate Education (RMAPO)).
Communities of Sisters of Charity. A qualitatively new stage in the development of nursing in Russia is associated with the organization of communities of sisters of mercy. On the initiative of Grand Duchess Alexandra Nikolaevna and Princess Theresa of Oldenburg, the first community of sisters of mercy in Russia was created in St. Petersburg (1844). The community received its name - Holy Trinity - only in 1873. The first community of sisters of mercy in Russia was based on the idea that caring for the sick and other forms of mercy could be a matter of personal achievement.
Initially, the community included seven departments: a department of sisters of mercy, a women's hospital, an almshouse for the incurable, a boarding house, a shelter for visiting children, a reformatory children's school, a department of penitents, or Magdalenes. Over time, most branches were closed. The community's activities were aimed exclusively at serving the poor and training sisters of mercy. During the opening years of the community, it consisted of 18 sisters of mercy and test subjects.
Widows and girls from 20 to 40 years old were accepted as sisters of mercy. Over the course of a year, the subjects underwent a training course and actually tested their mental and physical qualities necessary for this difficult work. The training of nurses was carried out by doctors serving in the community. Nurses were taught the rules of patient care, wound dressing techniques, pharmacy and recipes. Trained nurses performed duties that were otherwise assigned to medical assistants and paramedics. They received the sick, visited the community, and were on duty in the community hospital and private homes. Over time, they began to be invited to private and public hospitals and hospitals. Many famous doctors were invited to the community for consultations. From 1845 to 1856, the community was visited by N.I. Pirogov.
The community's activities quickly gained recognition. There was no shortage of people willing to take part in the work. However, living conditions in the communities differed sharply from those of the “compassionate widows.” Fulfillment of difficult and complex duties, ascetic life, discipline, lack of salary, pension, days off and vacations led to many sisters leaving the community. Only a quarter of the sisters stayed in the community for more than 10 years. Nevertheless, their work was more significant in terms of the volume and quality of medical care for the population than the activities of “compassionate widows.”
Since the demand for the activities of the sisters of mercy far exceeded the capacity of one community, there was a need to create new communities.
At the end of 1844 in St. Petersburg, Princess M.F. Baryatinskaya founded a community to help the needy and suffering, which a little later received a charter and the name “Community in the name of Christ the Savior.” From 1853 to 1875, 23 sisters of the community provided assistance to 103,785 patients.
In Moscow by the middle of the 19th century. There were few similar establishments. A community similar to Holy Trinity arose in Moscow in 1848 during a cholera epidemic. It was organized by two outstanding people: Princess Sofya Stepanovna Shcherbatova and Doctor Fyodor Petrovich Gaaz. This community received the name Nikolskaya. The sisters of this community took part in caring for the wounded during the Crimean campaign.
In 1850, the Sturdzovskaya almshouse for compassionate sisters was established in Odessa, which consisted of a community of sisters and a hospital in which they were trained. Only female patients received medical care in this hospital. At the hospital there was a senior doctor and several doctors and assistant doctors.
To participate in the Crimean War (1853-1856), the Holy Cross community of sisters of mercy was created.
The movement of the sisters of mercy after the Crimean campaign received a wide response in the hearts of the Russian people. One after another, new communities of sisters of mercy are opening in different cities of Russia: Moscow, St. Petersburg, Kharkov, Tiflis, etc.
Those wishing to enter the community previously underwent a probationary period of up to two years. In peacetime, the sisters looked after
patients in military hospitals and civilian hospitals, in the apartments of private individuals. In wartime, they were seconded by the community council to the Russian Red Cross Society and distributed among hospitals.
By becoming members of the community, the sisters took on hard work and high moral responsibility. This was a special form of asceticism, which only the strong in spirit could endure. They received no pensions, had no days off, no vacations. The communities were a kind of communes. They operated orphanages and schools, hospitals and outpatient clinics, craft and art workshops, and permanent nursing courses.
The charters of the communities differed little from each other. Their constant conditions were chastity and severity of behavior, love and mercy for one's neighbor, hard work and dedication, discipline and unquestioning submission to superiors. The statutes were strict, but retained some freedoms for community members (unlike monastic ones). The sisters had the right to own inheritance and their own property; if they wished, they could return to their parents who required care, or marry. Among the sisters of mercy there were many women and girls of noble origin. For example, Princess Shakhovskaya began her social activities as a nurse in the Moscow prison hospital. However, the charter did not allow anyone to make discounts, and no one sought privileges.
At the beginning of the 20th century. The management of charitable institutions was headed by Grand Duchess Elizaveta Feodorovna. In 1905, her husband, Grand Duke Sergei Alexandrovich, governor of Moscow, was killed. After this, the princess devoted herself entirely to charity. In 1907, Elizaveta Fedorovna established a community of sisters of mercy - the Martha and Mary Convent, named after two evangelical sisters, in whose fate two ideas were embodied: spiritual service and active charity. The community included a hospital, an outpatient clinic, a pharmacy, a shelter for orphan girls, and a Sunday school. There was also a canteen for the poor, a dormitory for the Sisters of Charity and the dormitories of an orphanage. The community ensemble was conceived by the princess herself. She had a subtle artistic taste and drew well. A beautiful park with greenhouses was laid out on the territory of the community. The monastery hospital was considered exemplary at that time. The best specialists worked there
Moscow. At the outpatient clinic, medical care was provided free of charge, and medications were provided free of charge at the pharmacy. The community helped with finding a job, home care, looked after children, and provided material assistance in the form of distributing money, clothing, and food. The Sisters of Charity, together with the Grand Duchess, visited slums and prisons. Elizaveta Fedorovna treated her duties very selflessly, cared for hopeless patients, took care of the sisters of the community, walked around the wards at night, and assisted during operations. She was very strict with herself, led an ascetic life: she slept no more than 3 hours on a wooden bed without a mattress, and was very abstinent in food.
In 1914, the monastery was converted into a hospital, the wounded were admitted here, and the Empress and her daughters worked here as sisters of mercy. The activities of the monastery continued after the revolution of 1917, until the arrest of the royal family. Elizaveta Fedorovna died tragically in 1918 in Alapaevsk along with other members of the royal family. At the end of the 20th century. Elizaveta Fedorovna and her cell attendant Varvara were canonized by the Russian Orthodox Church. Currently, the Grand Duchess has many admirers not only in our country, but also abroad. The Marfo-Mariinskaya Convent works, preserving the memory of its founder. In Moscow, on Bolshaya Ordynka, a monument to a woman was unveiled, whose dedication for the good of the Fatherland, in the name of love and compassion for people, can serve as an example to follow. In August 2004, the relics of the sister of mercy, Saint Elizabeth, visited Moscow, and admirers of this most illustrious woman could venerate them.
The existence of communities of mercy was a remarkable example of asceticism, which was picked up by Russian society in the second half of the 19th century. Women have proven that they deserve to have equal rights with men in the public life of the country.
The movement of the Sisters of Charity quickly gained strength and received universal recognition. By the end of 1912, 3,442 nurses worked in 109 charitable communities, and by the beginning of the First World War their number reached almost 20,000.
During the Crimean War (1853-1856), the shortage of medical personnel was especially acute. This war claimed the lives of almost 785,000 people. At the same time, the loss in killed was 53,000, and the rest died from wounds and disease. At the height of hostilities N.I. Pirogov was invited to Grand Duchess Elena Pavlovna, who in 1828 took over the leadership of charitable institutions. She introduced him to her plan - to create a women's organization to help the sick and wounded on the battlefield and invited N.I. Pirogov to take over the organization.
In 1854, the Exaltation of the Cross community of sisters of mercy was created in St. Petersburg, specifically for work in the army. The community charter was drawn up by N.I. himself. Pirogov. And he also led the activities of the community. The new initiative was met with skepticism in high circles. Concerns were expressed that sending a woman to the front could lead to moral decay in the army. However, women, with their selfless work and impeccable behavior, earned the respect and gratitude of not only soldiers, but also the entire people, writing a glorious page in the history of the development of nursing and domestic healthcare in general.
N.I. Pirogov highly appreciated the hard work, dedication and great moral influence that the sisters of mercy had on the soldiers. He wrote that the behavior of the sisters with doctors and their assistants was exemplary and worthy of respect, their treatment of the suffering was the most sincere, and in general all the actions of the sisters when caring for the sick, in comparison with the behavior of the hospital administration, should be called nothing less than noble.
During the Crimean War, Russian women for the first time left the sphere of domestic life in the field of public service, showing high business and moral qualities. The sisters acquired one of the specialties: surgical nurses (dressing nurses), pharmacists and housewives. Dressing nurses helped doctors during operations and dressings, and prepared dressings. Sister-housewives supervised the care of the sick, the cleanliness of linen and beds. Nurse pharmacists had to monitor the correct distribution of medicines and checked the work of paramedics.
“Compassionate widows” worked together with the sisters of the Holy Cross and St. Nicholas communities in Crimea. The best evidence of the selfless work of women is the fact that 12 widows died. Of the 60 sisters of mercy, almost all fell ill with typhus, 11 of them died.
The events of those years were preserved in the reports of the great surgeon, his memoirs and diary entries. They are most fully reflected in the “Sevastopol Letters”, which were documents of political content and had a significant influence on public opinion in Russia. Memories left us with the names of these great women, including noblewomen E. Bakunina, E. Khitrovo, A. Travina, M. Grigorieva and others.
Ekaterina Mikhailovna Bakunina (1812-1894) was distinguished by her unusually high moral and strong-willed qualities and precise performance of her duties as a nurse. N.I. Pirogov called her a tireless sister and considered her his faithful assistant. “Every day, day and night,” he recalls, “one could find her in the operating room, present at the operation, at a time when bombs and missiles either flew over or did not reach and lay around, ... she discovered with her accomplices a presence of mind barely compatible with female nature.”
Ekaterina Mikhailovna was raised in the spirit of the best family and national traditions, on the wonderful images of Russian classical literature. Her pedigree is the interweaving of two famous families in Russia: the Bakunins and the Golenishchev-Kutuzovs. Ekaterina Mikhailovna’s grandfather Ivan Loginovich had a friendship with Mikhail Illarionovich Kutuzov for many years, and they were married to sisters, so Ekaterina Mikhailovna can be considered the grandniece of the great commander.
In her declining years, Ekaterina Bakunina wrote “Memoirs of a Sister of Mercy,” the only one of its kind in the entire vast literature about the Crimean War, not counting “The Historical Mode of Action of the Holy Cross Community...” by N.I. himself. Pirogov.
In the first post-war years E.M. Bakunina, on the recommendation of Pirogov, led the Holy Cross community. But in the summer of 1860, she voluntarily resigned as sister abbess and parted with the community forever. The reason for such a serious step was disagreements with Elena Pavlovna on issues of further development and activities of the community. Further life of E.M. Bakunina confirmed the spiritual richness of her nature: until the end of her days, she tirelessly struggled with human misfortune - she treated peasants in the village of Kozitsino, Novotorsky district, Tver province, where she lived with her sisters. Participation in the Russian-Turkish War is one of the brightest pages of her interesting, but not yet written biography.
In the memoirs of N.I. Pirogov, doctors, and contemporaries, information about Daria Lavrentievna Mikhailova (real name Dasha Sevastopolskaya) has been preserved. She was one of those wives, sisters, daughters of Sevastopol residents who, even before the appearance of sisters of mercy and “compassionate widows,” provided assistance to the wounded. One of his contemporaries wrote that Dasha, who was left an orphan, first earned money by washing clothes and, together with the laundresses, followed the troops with her cart. Fortunately, in her cart there was both vinegar and some rags, which she used to bandage her wounds. Thus, Daria Mikhailova became the first sister of mercy on the battlefield.
Nicholas I learned about the girl’s feat from letters from his sons, who were in Crimea to “raise the spirit” of the Russian army, and took direct part in the girl’s fate. Daria was awarded a gold medal on the Vladimir ribbon with the inscription “For zeal” and 500 rubles in silver. She lived a long, modest life without reminding of herself. Unfortunately, neither the date of her death nor the place of burial have been established.
On the occasion of the 150th anniversary of the birth of Dasha of Sevastopol, on the initiative of the command of the medical service of the Red Banner Black Sea Fleet, the Red Banner Naval Hospital named after N.I. Pirogov and the Council of the Museum of the Fleet Medical Service approved a medal named after her. It was manufactured at the Sergo Ordzhonikidze Marine Plant production association. Every year the hospital hosts a competition for the title of best nurse. Those who occupy the highest step of the podium are awarded a medal named after Dasha of Sevastopol and are included on the Honor Board.
Efforts of N.I. Pirogov and the sisters themselves were not in vain. In his memoirs, he wrote that the results of the sisters’ participation in the war and the first experience of creating communities proves that until now the wonderful talents of our women have been completely ignored. He was worried about the future of the community, its internal life. “Our sister,” wrote Pirogov, “must be a woman with a practical mind and a good technical education, and at the same time she must certainly maintain the sensitivity of her heart, and such activity in women must be constantly supported. The nurses themselves must be independent of the administration, and the most educated must morally influence all hospital staff.” He believed that the activities of the sisters of mercy, despite all the difficulties, had a great future. He sums up the activities of the Holy Cross community this way: “...I hope that this young institution will be introduced in our other military hospitals forever. Every right-thinking doctor who wants his orders not to be carried out by the rough hand of a paramedic must sincerely wish for the prosperity of compassionate care for the sick.”
At the end of the war, 68 sisters were nominated for the medal “For the Defense of Sevastopol”. Of the 120 sisters of mercy of the Holy Cross community sent to Crimea, 17 died in the line of duty. Their memory is sacred to us.
Participation in the Russian-Turkish War (1877-1878). The heroine of the Russian-Turkish war was the sister of mercy Yulia Vrevskaya. Baroness, the daughter of a general, she considered “self-sacrifice for the good of others” her duty. V.A. Sologub wrote: “I have never met such a captivating woman in my entire life. Captivating not only for her appearance, but also for her femininity, grace, endless friendliness and endless kindness. This woman never said anything bad about anyone and did not allow anyone to slander anyone, but, on the contrary, she always tried to bring out the good sides in everyone.” From the very beginning of the war, Yulia goes to the front: “For 400 people, there are 5 of us sisters, the wounds are all very serious. I'm in the hospital all day." Yulia Vrevskaya refused her allotted leave and died of typhus in a military hospital in the Bulgarian city of Byala on January 24, 1878. In memory of Yu.P. Vrevskoy dedicated his prose poem to I.S. Turgenev.
Russian Red Cross Society. The founding meeting of the Society for the Care of Wounded and Sick Soldiers took place in St. Petersburg on May 18, 1867. Renamed the Russian Red Cross Society (ROSC) in 1879, it became a wealthy and influential organization carrying out missions to help the wounded in war and those affected by natural disasters. disasters both within the country and abroad.
In 1879, the competence of the ROKK included: organizing the training of sisters of mercy and monitoring the establishment and activities of communities of mercy. Most communities joined the ROKK, including the famous Holy Cross in St. Petersburg. By January 1, 1894, the ROCC had 49 mercy communities at its disposal. In 1903, the network of ROKK institutions with headquarters in St. Petersburg consisted of departments, committees, communities of sisters, hospitals, outpatient clinics, nursing homes, and orphanages.
In 1897, the Russian Red Cross Society established the Institute of Brothers of Charity in St. Petersburg, the purpose of which was to train male personnel to care for the sick and wounded and provide assistance in accidents. The training lasted 2 years. Except
communities of the Red Cross, training of sisters was also carried out at hospitals and monasteries.
The number of women who aspired to become sisters was constantly growing. Nursing training courses were organized in many large cities for all those wishing to join the profession. For future nurses, lectures were given and practical classes were conducted under the guidance of surgeons and special curators, in accordance with the standards and programs developed by the leaders of the RCCS.
The sisters' work was very highly paid, and their status was equal to that of a captain or major in the Russian army. In addition to the monthly allowance, which was higher than that of officers, women received additional funds for travel and sewing several sets of uniforms. In addition, the ROKK guaranteed pensions after 25 years of service and payment of benefits in case of illness acquired during the performance of official duties.

Development of nursing in 1918-1977.

The main events of this period of nursing development are presented in the table;
Analyzing the main milestones in the development of nursing in the post-October period, it should be said that the reforms began with the approval in 1919 by the People's Commissar of Health of the training plan and programs for schools of sisters of mercy, which provided for a purely practical method of teaching and, therefore, the constant stay of students in the hospital.
The young country needed new sisters who could be trained by schools that were fundamentally different from the schools of mercy. Thus, in 1920, the word “mercy” disappeared from medical usage. Communities of sisters of mercy are liquidated, the first state medical schools appear. In the new programs of the 1924 edition, it was noted that “the nurse must not only be a mechanical executor of the doctor’s prescription, but must be clearly aware of the significance of the specified method of treatment”; in the 1926 programs - that “the average health worker should only be an assistant to the doctor, working according to his instructions and under his supervision.” And only in 1929 was the issue of improving the qualifications of nursing staff resolved (at least once every 5 years).

Table. Main milestones in the development of nursing in Russia in 1919-1977.

After the nurse's specialty was reinstated (circa 1932), new training requirements specified that she perform nursing care under the direction of a physician or physician's assistant, and that she must be medically literate in order to be conscientious about the physician's orders.
In 1934, mass training of adults began under the GSO program (Ready for the sanitary defense of the USSR), as well as training for schoolchildren under the BGSO program (Be ready for the sanitary defense of the USSR). These programs included issues of first aid for wounds, injuries, issues of hygiene, sanitary care, and infectious diseases. At the same time, sanitary squads and posts were formed.
In 1936, a unified system for training paramedical personnel was introduced. Since 1939, the training of nurses began in each republic. Already in 1940, there were 967 medical and sanitary schools and departments in the former USSR.
During the Great Patriotic War, for the first time in the world in the Soviet army, a woman was brought to the line of fire - a sanitary instructor, whose duties included carrying out the wounded and providing them with emergency care. On August 23, 1941, an order was issued “On the procedure for providing medical instructors and porters with government awards.” For removing 15 wounded from the battlefield with their rifles and light machine guns, the medical instructor was presented with a government award - the medal “For Military Merit” or “For Courage”; for the removal of 25 wounded - the Order of the Red Star; for the removal of 40 wounded with their rifles and light machine guns - to the Order of the Red Banner; for the removal of 80 wounded with their rifles and light machine guns - to the Order of Lenin. In the German army, only men were used as orderlies and medical instructors. For 7 wounded carried out (without personal weapons) the Iron Cross was awarded.
Yulia Drunina, a famous poet and public figure, a former battalion medical instructor, holder of the military orders of the Patriotic War, 1st degree, and the Red Star, writes: “I do not come from childhood, from war... How many times has it happened to me - I need to take a wounded man out from under fire , but not enough strength. I want to unclench the fighter’s fingers to free the rifle - after all, it will be easier to drag. But the fighter grabbed her with a death grip. Almost without memory, but my hands remember the first soldier’s commandment - never, under any circumstances, throw away your weapon.”
The mortality rate among company instructors was the highest, sometimes only 30% of the personnel emerged from battles. “Not a single wounded person should remain on the battlefield” - this requirement in the difficult year of 1941 was not only a call. The everyday life of war knows many cases when the rescue of one wounded man cost the lives of two or three orderlies, although their actions were often covered by the fire of an entire unit. Our country takes credit for organizing women's sanitary care on the battlefield. But is this something to be proud of?
24 medical instructors were awarded the title of Hero of the Soviet Union, including 10 people posthumously. The poet M. Svetlov wrote about them, about the dead:
On a long stretcher, under a canopy
Russian princesses were dying. Machine gunners stood quietly nearby in State Sadness. The Yegoryevsk Medical School in the Moscow region is named after Zinaida Samsonova. She was a fighting friend of Yulia Drunina. The poem “Zinka” is dedicated to her.
We did not expect posthumous glory, We wanted to live with glory. Why is the Blonde soldier lying in bloody bandages? According to generalized data, first aid was provided within the first hour after injury to 66.5% of all wounded, and 88.6% received it in the first 2 hours. This was important to achieve good treatment results. After recovery, 72.3% of the wounded and 90.6% of the sick were returned to duty.
War is over. “You took off your soldier’s overcoat, put on your old shoes” and began your pre-war duties. In 1961, 2 participants of the Great Patriotic War - guard lieutenant colonel of tank forces, writer, Hero of the Soviet Union, Muscovite Irina Nikolaevna Levchenko and surgical nurse, chairman of the primary organization of the Red Cross of the Leningrad Skorokhod factory Lidia Filippovna Savchenko - were awarded the Florence medal for the first time in Russia Nightingale.
Starting from 1954, in accordance with the resolution of the Council of Ministers of the USSR of May 14, the terms of study were unified depending on general training (based on 9- and 11-year education), the network of medical schools was streamlined, and specialization was introduced for nurses in therapeutic nutrition, massage, physiotherapy, physical therapy, anesthesiology, etc.
An analysis of changes in nursing during this period shows that the main focus was on educational reform. This is evidenced by fairly frequent revisions of curricula, which differed from each other only in the number of academic disciplines of the “university” set.
From our point of view, this did not in any way affect the activities of practical nurses. Their professional and social status, determined back in 1927, is basically preserved in Russian healthcare to this day. A conscious attitude towards the doctor’s prescriptions, even if it is developed, remains unclaimed among the majority of nurses: the doctor bears responsibility.

Conclusions for nursing development

Interconnectedly it includes issues of the place and role of a woman in society, her professional abilities and professional self-realization, as well as the formation of various professions.
- The first women's religious organization that was involved in charity was founded in France in 1633.
- One of the factors that hindered the development of nursing in the world was the social status of women. Florence Nightingale made a huge contribution to women's equality. She was the first to draw attention to the significance and features of nursing, which determine its specificity and its separation into an independent type of professional activity. On her initiative, the world's first secular school for training nurses was opened in London in 1860.
- In 1899, the International Council of Nurses was created - the first professional organization of women.
- The first organizer and legislator of nursing in Russia was Peter I, on the basis of whose decrees women’s care work began to be used, and then increasingly specified and specified. At the same time, in the 18th century. Women's participation in care was not systematic. According to the staff, the hospitals had both soldier-sitters and women-sitters.
- In the first half of the 19th century. the service of “compassionate widows” remained the only form of women’s participation in caring for the sick
in Russia. With the establishment of the Institute of Compassionate Widows (1819), the training of female medical personnel began.
- "Management." H. Oppel (1822) was the first work known to us that made an attempt to emphasize the importance of the activities of nursing staff, highlight the specifics of the work of nurses in various specialties, and also outline the structure of activities and professional knowledge.
- The first community of Russian sisters of mercy - Holy Trinity - was created in 1844 in St. Petersburg.
- In 1854, the Exaltation of the Cross community of sisters of mercy was created in St. Petersburg, specifically intended for work in the army. The community charter was drawn up by N.I. Pirogov. During the war, the sisters acquired one of the specialties: surgical nurses (dressing nurses), pharmacists and housewives. History has preserved the names of those great women: D. Sevastopolskaya, E. Bakunina, E. Khitrovo, A. Travina, M. Grigorieva and others.
- In 1867, the Russian Red Cross Society was established. His competence included organizing the training of sisters of mercy and monitoring the establishment and activities of communities of mercy.
- At the beginning of the 20th century, the leadership of charitable institutions was headed by Grand Duchess Elizaveta Feodorovna, who at the end of the century was canonized by the Russian Orthodox Church.
- The movement of communities of mercy is a wonderful example of asceticism. Communities of Sisters of Mercy played a major role in the development of women's intellectual and emotional potential in Russia.
- In 1920, the first state medical schools appeared in Russia. In 1929, the issue of improving nursing staff was resolved, the frequency of which (at least once every 5 years) continues to this day. In 1936, a unified system for training paramedical personnel was introduced.
- During the Great Patriotic War, for the first time in the world, a female medical instructor was placed in the line of fire in the Soviet army. 24 medical instructors were awarded the title of Hero of the Soviet Union, including 10 people posthumously.
- An analysis of changes in nursing shows that from 1945 to 1986 the focus was on educational reform. From our point of view, this did not in any way affect the activities of practical nurses. Their professional and social status, determined back in 1927, is basically preserved in Russian healthcare to this day.
- Some damage to the prestige of the nursing profession has been and is being caused by the fact that a nurse performs the function of a doctor’s assistant, and abroad the concept of partnership between these specialists is increasingly being established.
- The attitude towards a nurse only as a doctor’s assistant and the concept of “paramedical worker” hinders the development of professional self-awareness of nurses. The lack of scientific principles in the system of training nurses and prospects for professional growth gave rise to many problems in Russian healthcare.

Fundamentals of nursing: textbook. - M.: GEOTAR-Media, 2008. Ostrovskaya I.V., Shirokova N.V.

Section 1. PM 04 Communication and learning in nursing

MDK 04.01. Theory and practice of nursing

Topic 1.1. Formation and development of nursing in Russia and abroad.

Lecture 1. History of the development of nursing.

1. The history of nursing as part of human history.

2. Sources of information about nursing. Nursing in monuments of literature and art.

3. The influence of Christianity on the development of nursing.

4. Three folklore images of sisters of mercy.

5. F. Nightingale (1820 – 1910) – founder of nursing. International recognition of the work of Florence Nightingale.

6. History of the formation of national societies and international organizations of the Red Cross and Red Crescent.

7. The role of Henri Dunant in the creation of the International Organization for Relief to War Victims.

8. History of the creation and tasks of the World Health Organization.

9. International sister organizations.

The history of diabetes spans thousands of years. SD is called the most ancient art and the youngest profession. Throughout the development of civilization, the sick and suffering have always been cared for in one way or another.

The ancient Greek cultural document “The Seven Commandments of True Charity” reads: “Feed the hungry, give water to the thirsty, clothe the hungry, shelter the sick, bury the dead.”

When people talk about the history of medicine, they often remember the names of great doctors: Hippocrates, Galen, Ibn Sina, Pirogov, Botkin, Sklifosovsky, Bekhterev, Ilizarov and many others, as well as the history of the development of diagnostics, pharmacology, deontology and other components of healing. At the same time, they completely forget about the role of nurses, paramedics, and midwives. “Nursing” comes from the verb “to nurse” (Latin nutrix - to feed), translated as “to look after (someone, something), care for, encourage, look after, inspire, feed, protect, educate and provide therapeutic care in case of ill health." It should also be noted that the noun “nurse” in English has no gender (like, for example, doctor), although in Russian it is translated as the feminine word “nurse”.

When and how did nursing appear as a concept and as a practice of caring for patients? Familiarization with a number of historical and medical works by domestic and foreign authors allowed us to conclude that that nursing is older than medicine and civilization. These are materials of a paleopathological nature, identified during archaeological excavations and indicating that people of the Mousterian time (about 100 thousand years BC) Moustiers is a cave on the banks of the Veser River, in France, where a site was found for ancient people, the so-called Neanderthals, who were more highly developed and had more advanced technology than the most ancient people of the beginning of the Lower Paleolithic (including Sinanthropus (100-40 thousand years ago) survived fractures, wounds, and ritual trepanations thanks to nursing.

History gives reason to believe that it was a woman who was the first doctor of our planet, and the folk epic has preserved a good memory of this. The woman, as the head of the clan, cared not only about food and maintaining the hearth, but also about the well-being and health of her relatives.

The ancient Slavs called them “bereginya”. Primitive man perpetuated the memory of women, leaving their images: stone sculptures of female ancestors, female guardians of the hearth. Women - “beregins” are found today on all continents and numerous islands of our planet in archaeological layers dating back to the Late Paleolithic. History has not preserved detailed information about the first women doctors. But the folk epic from time immemorial has brought to us the names of healers who lived in the era of matriarchy: in Egypt - the Mighty Polydamna, in the Czech Republic - the wise Kaza, in Colchis - Medea.

As a specialty, nursing was formed in the middle of the 19th century, almost simultaneously in Russia and the West, and by the end of the 20th century. flourished in the USA and other countries. In Russia, it appeared as one of the lowest paid and most unprestigious professions.

Attempts to understand the reasons that gave rise to the current situation and hinder the way out of it lead us to the need to trace the history of the development of nursing in the world in general, and in Russia in particular.

Among the peoples of the Ancient World, relatives cared for the sick. There were no special people who would devote themselves to caring for the sick, the only exception being women involved in providing assistance to mothers and newborns. At first these were elderly relatives, but over time special specialists appeared. The organization of such assistance reached its greatest development among the Greeks and Romans.

In Ancient Greece there were midwives, which, according to Hippocrates, could only be women who gave birth, as well as women with extensive life experience. They determined the timing of pregnancy and the onset of childbirth, and they were given the right to speed up childbirth with medicines and sacred songs.

In Athens and Rome, sick poor people and soldiers wounded in battle were treated in the homes of wealthy citizens, where women cared for them.

Approximately the first five centuries AD. Nursing care consisted mainly of performing hygienic measures and creating comfortable conditions for the needy, homeless and sick. It was provided mainly by early Christians, both individually and within the framework of the Christian Church. In ancient Rome, for a long time, anyone could even treat the sick. But, as a rule, this occupation, “despicable” from the point of view of the patricians, was the lot of slaves of Greek or Jewish origin.

The main methods of healing in slave society were spells, prayers, amulets, and sacrifices. Over time, with the addition of knowledge about caring for the sick, home remedies began to be used - coal, soot, ash, cold and warm water, peace, good food, clean air, herbs, various massages, prayers and rituals.

In subsequent centuries, as Christianity established itself as the dominant religion in Europe,

Why did Christianity serve as the impetus for the development of human health care? "Christianity had a great deal to do with recognizing the value of each individual person as an individual. To serve man was to serve God."

The Church took upon itself the care of the weak and sick. This responsibility rested with deacons and deaconesses. It was not only women who cared for the sick and dying. During the Crusades (12th century), paramilitary medical orders appeared, for example, the Teutonic Knights. After military campaigns, many monasteries were founded, where the body of necessary knowledge and skills included the ability to provide medical care. Since education could be obtained there, many young people flocked to monasteries to study medicine.

For example, members of the Order of Saint Lazarus in Jerusalem devoted themselves to caring for lepers. From the name of the Order of St. Lazarus is where the name of the infirmary came from. The spiritual-knightly order of the Hospitallers, founded by the crusaders in Palestine, named after the Jerusalem hospital of St. John - a hospice for pilgrims. It is not without interest that the Russian Emperor Paul I was elected its Grand Master in 1798. Since the 12th century, spiritual care for the sick - hospital brothers and sisters - has appeared. The Order of the Brothers of Charity was founded in 1540 in Spain. Community of St. Elizabeth (“Elizabeth”) existed since the 13th century in Germany.

In the 12th century, various teachings and treatises on caring for the sick appeared. One of the treatises belongs to the Salerno school. The Salerno Medical School arose in southern Italy in the 9th century and in 1213 became part of the University of Salerno as a faculty. Scientists of this school wrote many essays on caring for the sick (for example, Ferrari wrote a study on fever, Muzandin wrote an essay on preparing food and drinks for the sick. Arnold of Villanova is the creator of a treatise written in verse entitled: “Regimen sanitatis Salernitanum” - “ Salerno Code of Health "This code formulates the rules of daily routine and nutrition, discusses in detail the properties of various foods, fruits and plants and their medicinal effects. A significant place in these instructions is occupied by descriptions of rational movements and ablutions, to which Salerno’s ancient predecessors paid great attention. The Salerno prescriptions for maintaining health have not lost their significance today and largely correspond to modern hygienic and dietary requirements).

In 1633, a congregation (Daughters of Charity) was founded in Paris. It was the first openly religious women's organization that was engaged in charity. Her activities, initially aimed at caring for the poor at home, eventually began to include teaching poor children, working in hospitals, and caring for the wounded.

In Germany, communities of sisters of mercy were created back in 1808. In Italy, sisters of mercy appeared only in 1821. Their main task was to care for infectious patients who were not accepted by hospitals. Twice a week they visited patients with chronic diseases at home and provided them with food and medicines prescribed by doctors.

Thus, the historical information that has reached us about the development of care and care for the sick in society gives us an idea of ​​the nature of the assistance provided, about those suffering from this assistance and, finally, about the representatives of “God-pleasing” mercy themselves, who are an inexhaustible source of goodness and love , patience, skill and compassion to this day.

By the middle of the 19th century. in Western Europe there were already about 16 thousand sisters of mercy.

I. It is known that the origins of the development of nursing abroad are three early images of the nurse.

This is a folklore image of “sister-mother” - a period when care for the sick was carried out at home by women from among the household and was limited to treatment with rituals and herbs. Another religious image of “God’s worker” is a period characterized by the appearance of all kinds of almshouses, where church ministers looked after the sick. And the third stage (the “dark” period), this is the image of the “servant” - when people who received special education began to provide help. The peculiarity and disadvantage of the last period is that the nurse acts only as an executor of the doctor’s instructions.

In the development of nursing in European countries in the 19th century, the activities of an outstanding personality, an Englishwoman, played a major role Florence Nightingale (1820-1910).

Florence was born in Florence, Italy, into a wealthy aristocratic family and received an excellent education for a woman of her time.

She knew literature very well, spoke five foreign languages, studied mathematics and natural sciences, and studied painting and music. But a calm and prosperous life did not attract the girl.

Florence was looking for an opportunity to actively help the poor and sick. But at that distant time, activities related to mercy and helping those in need were considered an activity unworthy of a noble woman.

During the Crimean War, she established field services for the wounded in the English army, contributed to the creation of field kitchens, soldier baths and laundries, supplying hospitals with hospital clothing, food, and dressings, which led to a reduction in mortality in hospitals and a significant improvement in medical care in the English army. She organized the world's first nursing school at St. Thomas Hospital (London). She is the author of works on the system of care for the sick and wounded, some of which have been translated into Russian. She dedicated her entire life to improving sanitary conditions in hospitals. On her tomb in Florence there is an inscription: “She was an example of service to people and a prototype of international charity, the bearer of which later became the Red Cross.”

After the end of the Crimean War, Florence Nightingale continued her work in medicine, but at a different level. She writes many books and articles on the purpose, role, activities and training of nurses. Such works as “Notes on Hospitals”, “Notes on Nursing”, “How to Care for the Sick” and many others were published, which receive enthusiastic praise from doctors even today. Miss Nightingale's influence on the status of women in Great Britain was enormous. In 1856, one high-ranking lady spoke of Miss Nightingale this way: “The most important thing Florence did was that thanks to her, public opinion about the capabilities of women and their work increased.” Florence devoted a lot of time and effort to training nurses. In 1860, on Nightingale's initiative, St. Thomas' Hospital was opened in London. test school for sisters of mercy. For 27 years, this school was run by a qualified nurse trained by Florence. Upon graduating from school, the sisters of mercy took a solemn oath drawn up by Nightingale, which contained the following words: “ I will do my best to help the doctor in his work and will devote myself to ensuring the health of those who turn to me for help.” Florence Nightingale died at the age of 90 and is buried in St. Paul's Cathedral in London. The selfless woman became an example of service to people and a prototype of international charity. A medal with her image is awarded for the special services of distinguished nurses. On the reverse side of the medal, a Latin inscription in a circle reads: “Pro Vera Misericordia et cara Humanitate Perennis décor universalis” - “For true mercy and care for people, arousing the admiration of all mankind” and in the middle is the engraved surname of the owner. The Florence Nightingale Medal was established in 1912. To date, about 1,000 people have been awarded this medal, including 46 Russian nurses.

Related information.

For the first time in Russia, female labor was used to care for the sick in hospitals and infirmaries under Peter I. By his decree, 1715 In 2010, educational homes were created in which women were supposed to serve. However, then the recruitment of women to work in hospitals was canceled. The role of caregivers was assigned to retired soldiers.

IN 1818 In the same year, the Institute of Compassionate Widows was created in Moscow, and special courses for nurses began to be organized at hospitals. From this time on, special training for female medical personnel began in Russia.

The first manual in Russian for special training of personnel (H. Oppel's textbook on nursing) was published in 1822. The manual by H. Oppel described the principles of selecting caring personnel, the requirements for their physical and moral qualities, i.e. for the first time the basics of deontology were given. Separate chapters of the manual were devoted to the peculiarities of caring for the seriously ill, recovering, and injured. For the first time, methods for performing basic medical procedures and rules for taking medications were described.

In 1844, on the initiative of Grand Duchess Alexandra Nikolaevna and Princess Theresa of Oldenburg, a secular compassionate institution was opened in St. Petersburg - Russia's first community of sisters of mercy, called "Holy Trinity". Widows and girls aged 20 to 40 were accepted into the community. The sisters were trained in caring for the sick, performing dressings, pharmacy, and compounding.

The historical reason for the creation of communities of nurses of a new type were the events of the Crimean War (1853-1856) on the initiative of N.I. Pirogova Grand Duchess Elena Pavlovna (sister of Emperor Nicholas I) established in 1854 Holy Cross a community intended primarily to provide assistance to the wounded and sick in the active army.

History has preserved the memory about the sisters of mercy during the Crimean War. Among the sisters of mercy, she occupies a special place Ekaterina Mikhailovna Bakunina - great-niece of Kutuzov, Moscow aristocrat. She became a sister of mercy during the Crimean War. Ekaterina Bakunina was one of the first to go as part of the Holy Cross community to Crimea to provide assistance to wounded and sick soldiers. Bakunina made a revolution in hospitals by introducing the service of nurses into them.

Widely known Ekaterina Petrovna Kartseva, who arrived in Crimea in 1855, and subsequently became one of the most famous sisters of mercy.

Won legendary fame Dasha Sevastopolskaya (Daria Lavrentievna Mikhailova)- the daughter of a sailor who died in the Crimean War. Daria Sevastopolskaya equipped the cart with rags, vinegar, cinnamon and went to the active army, where she organized the first dressing station. Nicholas I ordered “to award her a gold medal on the Vladimir ribbon with the signature “for zeal” and 500 rubles in silver.”

Ekaterina Alexandrovna Khitrovo- one of the first sisters of mercy, ally of N.I. Pirogov. During the Crimean War E.A. Khitrovo prepares and sends sisters of mercy from Odessa to the theater of military operations.

The movement of the sisters of mercy received a wide response in the hearts of the Russian people. New communities are opening one after another:

• In 1859, it was established in St. Petersburg Pokrovskaya community.
• In 1863 - community Mary Magdalene in Moscow.
• In 1866 - community "Quench My Sorrows" at the prison hospital.

The English sister Florence Nightingale is rightfully considered the founder of nursing. IN 1854 In 1999, British troops landed in Crimea to help Turkey in the war with Russia. F. Nightingale arrived in Turkey at the head of a detachment of 38 sisters to care for wounded soldiers. At the end of 1856, Florenz returned to England and organized a fundraiser to create a school for training sisters of mercy. In 1860 she opened the first modern nursing school of a new type in London at a hospital. The system of training nurses created by Florence Nightingale served as the basis for modern teaching of nursing throughout the world. F. Nightingale wrote her famous “Notes on Nursing” (1859), where she defined nursing as a profession and showed its difference from medicine.

International Committee of the Red Cross in 1912 In 2009, the Florence Nightingale Medal was established, which is awarded to sisters who showed heroism in the theater of military operations (during the Second World War, 46 sisters in our country were awarded this medal).

The Crimean War (1853-1856) required qualitatively new, qualified care for the sick and wounded. The idea of ​​helping the wounded by nurses was a prerequisite for the organization of the Red Cross Society. The founder of the organization was Swiss citizen Henri Dunant. He was amazed by the suffering of the wounded and the activities of F. Nightingale, N.I. Pirogov and his squad of sisters during the war. The emblem of the society was a red cross on a white canvas (the flag of Dunant's homeland is a white cross on a red one).

The beginning of a serious restructuring and further development of the system of sisters of mercy communities in Russia was the creation in 1867 "Societies for the Care of the Sick and Wounded." It united disparate attempts to train nurses. In accordance with the Charter, the Society was obliged to organize care for the sick and wounded during the war, and in peacetime to train medical personnel: paramedics, nurses, orderlies.

IN 1876 year it was renamed to "Russian Red Cross Society", which became part of the international organization "Red Cross".

The first real test for the Red Cross was the Russian-Turkish War (1877-1878). The need for sisters has increased several times. Urgent training of new nurses has begun in 1.5-2 month courses. The acquired knowledge was tested through an exam and Red Cross certificates were issued.

During this period in the history of nursing, one cannot help but remember the wonderful sister of mercy Yulia Pavlovna Vrevskaya. Baroness Yu.P. During the Russian-Turkish war in the Balkans, Vrevskaya was a nurse in the evacuation hospital of the active Russian army. Sung by Turgenev and Hugo, she died of typhus in a Bulgarian village.

With the establishment of the Russian Red Cross Society, its competence included organizing the training of sisters of mercy and monitoring the establishment and activities of communities of sisters of mercy. The training of nurses was carried out for 1.5-2 years. The course consisted of practical and theoretical sections, teaching was conducted in KK’s own medical institutions, hospitals, city and zemstvo hospitals, and private hospitals. Upon completion of training, the sisters passed an exam and transferred to the rights of subjects for 2 years, after which they received a certificate of sister of mercy.

IN 1894 In 2009, the Russian Red Cross Society had 49 communities of nurses at its disposal, with 1,074 sisters.

IN 1897 In 2006, the ROKK established the Brothers of Charity Institute with a two-year training period, the purpose of which was to train male personnel to care for the sick and wounded and provide assistance in accidents.

The system of Red Cross communities continued to develop, and by 1913 they existed in all provincial cities, as well as in some district centers and even in villages. Their total number was 109, in which there were 3442 sisters.

The first medical nursing schools in our country were organized in 1920 year. The Regulations on Schools especially emphasized the need for a practical teaching method. Therefore, it was recognized as necessary “for students to constantly stay in the hospital throughout the entire working day.” IN 1922 year there were 31 schools of sisters of mercy in Russia. In the same year, the first conference dedicated to issues of secondary medical education took place. IN 1926 - year to change the name " sister of Mercy"the name came" nurse». In 1927. approved Regulations on the nurse, which clearly defined the nurse's responsibilities for caring for patients. From this time on, the professional status of the nurse was defined.

WITH 1928 years, systematic training of nurses began to be carried out in our country.

During the Great Patriotic War, there were always nurses next to the sick and wounded behind enemy lines and on the front line, 17 nurses received the title of Hero of the Soviet Union, 46 were awarded the Florence Nightingale Medal.

During the war, the medical service of the Armed Forces, together with civilian healthcare, returned 72.3% of the wounded and 90.6% of the sick to duty after healing; The active army and the rear were protected from major epidemics.

IN 1953 In the same year, schools were reorganized into medical schools, and a system of secondary medical education was created. WITH 1991 training is carried out in schools and colleges throughout the year.

IN 1965 year, advanced training courses for paramedical workers are being created.

WITH 1971 F. Nightingale's birthday - May 12 - has been declared International Nurses Day.

History does not stand still; nursing is also developing. The requirements for the professional and personal qualities of a nurse are increasing.

IN 1993 year, an international conference on nursing theory was held in Golitsino, at which the question of the need was raised reforms education and diabetes to improve nursing practice.

IN 1994 In 2010, the Association of Russian Nurses was created, which takes part in the work of the International Council of Sisters.

IN 1995 The magazine “Nursing” was published in 2016.

IN 1997 The Association of Nurses creates the Code of Ethics for Russian Nurses.

IN 1998 The First All-Russian Congress of Paramedical Workers was held in St. Petersburg. The draft State Program for the Development of Nursing in the Russian Federation was approved.

Multi-level training of nursing specialists has been introduced - basic level, advanced level, higher nursing education (HNE).

In 1999, the publication of the magazine “Nurse” was resumed.

There are 3 stages in the development of nursing:

1st stage - the sister plays a guardian role (helping the disabled, dying, orphans).

2nd stage - associated with the Crimean campaign. The role of the nurse is that of a dependent executor of the doctor.

3rd stage - late 90s of the XX century. - beginning of the 11th century - the nurse performs the role of an independent specialist within her competence.