Nurses celebrate Nurses’ Day today, Florence Nightingale’s birthday. Nightingale is renowned for having introduced modern nursing in the UK

and in most of the Western countries.

As with other countries, nurses in Malta have always been portrayed as being female, in dresses and wearing particular caps on their heads. Nowadays they do not have such uniforms and the cap has long been put aside. Uniforms now consist of tunics and trousers and some nurses may carry items which have long been associated with other professions, as is the stethoscope which to the public represents the doctor, and the high -IT equipment which, in the past belonged elsewhere from nurses. But what else has changed in nursing in our country? The last couple of decades have seen changes in many other aspects of nursing. Most of these changes have come to be known only through word of mouth, as little has been documented.

Nurse education

Perhaps the greatest changes, and those that brought about much transformation within the nursing profession, were the changes which happened in nursing education. Nursing education has changed from being hospital-based at the St Luke’s School for Nurses, in Guardamangia to training programmes at the University of Malta. Nurse eduction in Malta went from being mainly organised by the Medical and Health Department to being delivered at a tertiary level of education, through programmes organised by the Faculty of Health Science, at the University of Malta.

Teaching of nursing students then was in the hands of nurses on the wards, led by nurse tutors and medical consultants and specialists. All was based on the medical model where the patient is viewed as having a disease or condition that needs to be cured. This curative approach contrasts with the holistic care advocated in today’s world.

The School for Nurses and its programmes was gradually phased out in the course of the introduction of Diploma and degree programmes at the University. Other courses have since been added to these that include MSc (Nursing), academic top-up programmes, as well as courses in mental health nursing and community nursing. Various post-graduate courses are offered regularly in specialisations as intensive care, Accident and Emergency.

Decades ago, a Certificate in Nursing course was also offered by the then Institute of Health Care (IHC) to replace the enrolled nursing course, which gradually ceased to be offered. Enrolled nurses have since been offered the opportunity to follow a conversion course organised by the Nursing Services Directorate, in order to be able to qualify for registration as registered (not enrolled) nurse.

The nursing element of the university courses was originally planned and taught by graduate nurse tutors brought specifically for the purpose from the UK. Nurse education is now based on a holistic view of the patient, where the biopsychosocial dimensions of each human being is taken into consideration when delivering care guided by sound knowledge of anatomy, physiology, aetiology, pharmacology and special concepts such as communication, stress, pain, sleep and empowerment. Practice placements, where student nurses learn through direct experiences in the clinical field, still make up a significant part of the training programmes in nursing.

Nursing practice

The change in nurse education brought with it a shift towards more evidence-based practice and care that incorporates the high technology that has become available for use in hospitals and in the community. Infection control has become more effective by the wide availability of gloves and plastic aprons, and the use of disposable items such as syringes, catheters, intravenous access equipment and wound dressings. Such advances have freed nurses of the tedious and undesirable tasks of washing and carefully inspecting equipment before this is boiled or otherwise disinfected for reuse. Arguably, this time has now been mostly taken up by the increased paperwork that needs to be done to ensure patient safety and continuity of care in the prevalent climate across modern healthcare systems.

Specialisation

The increasing widening advances in treatment available to patients in modern healthcare systems have led to specialisation in the field of medicine. This is being closely followed by that in nursing as nurses seek to gain competencies that become necessary with specialised care. Specialised nurses, such as those in continence care, stoma care, tissue viability, haematology and breast care, have come into increasing demand. Their contribution is also needed in general care areas, where patients may benefit from their expertise too. Some specialist clinical settings such as operating theatres and intensive care also call for specific competencies, which are expected of nurses in these clinical settings at all times.

Professionalisation

Heightened levels of knowledge and skill, and the appropriate application of both have led to professionalisation and autonomy of practice within the healthcare team. In Malta, the recent granting of the professional warrant to practising nurses has legally acknowledged the unique status of the nurse in our healthcare team.

Management

Nursing management organisation and styles have also changed in the last 50 years. The matron was the head of nursing in a hospital as a subordinate of the Medical Superintendent. In the past, for many decades, this post as well as most of the nursing officer posts, that is the posts held by nurses in charge of wards, were held by nuns from the Sisters of Charity. Nowadays, at Mater Dei Hospital, the Director of Nursing, a lay nurse with a masters level of education in the field of nursing, leads the nursing and midwifery hierarchy. Similar posts and similarly qualified nurses are mirrored across our healthcare system. Nursing and midwifery services on the national level are the responsibility of the Nursing Services Directorate, headed by the Director, Nursing Services within the Ministry for Health, Elderly and Community Care that was set up in 1997. This was a central milestone in the journey of nursing in Malta across the years.

The rate of change within the nursing profession in the last 50 years or so has been tremendous. Details of these changes need to be recorded and the hard work of nurses in the past acknowledged. The great changes in entry requirements, academic levels of training, uniforms, equipment, approaches to care, technology use, and decision making have made the profession hardly recognisable to that of the past. The one element that is constant is the mission to reach out and care for the patient; that was, and will always be the central activity of any kind of nursing. This one aspect has remained remarkably constant across the many centuries that Malta has been blessed with nurses.

Catherine Sharples, MSc(Nursing), BSc(Hons) (Nursing), SRN is currently reading for a doctoral degree in Nursing with special interest in the History of Nursing in Malta. Those who would like to share their experiences, photos or any other memorabilia related to nursing in Malta may contact the author by email on: [email protected] or on mobile number 9937-3562