3 19 th Annual Meeting of the Florence Network April 2011 Escola Superior de Enfermagem de Lisboa From Diagnosis to Outcomes: Researching Nursing and Midwifery Interventions Educational Challenges Abstracts ebook Editorial Coordination Curado, MA Leal, MT Santos, J Bronze, HC Lisboa 3
4 People in the Annual Meeting Andy Gibbs, Edinburgh Napier University President of the Florence Network Maria Teresa Leal, ESEL, Lisbon Chair of the 19 th Annual Meeting of the Florence Network ESEL SCIENTIFIC COMMITTEE ESEL STUDENT COMMITTEE Maria Teresa Leal Maria Ana Pêgo Maria Margarida F. Coelho Guilherme Marques Maria Alice Curado Filipa Grenho Cláudia Bacatum Maria Inês Barros Maria João Delgado Inês Barros Francisca Manso Maria Inês Santos ESEL ORGANIZING COMMITTEE João Santos Eunice Sá Ana Fialho Maria Ana Pêgo Guilherme Marques Helena Bronze Catarina Nunes Inês Nunes Silvério Pisa Tiago Santos Rita Santos Inês Diogo Joana Silva Maria Matilde Santos Raquel Cravinho Mariana Cravo 19th Annual Meeting of the Florence Network, April 2011 From Diagnosis to Outcomes: Researching Nursing and Midwifery Interventions Educational Challenges: Abstracts ebook. Published by Escola Superior de Enfermagem de Lisboa, April 2011, Lisboa Editorial Coordination: Curado, MA, Leal, MT, Santos, J, Bronze, HC ISBN No liability is assumed by the publisher with respect of the use of information contained herein. While every precaution has been taken in the preparation of this book, the published assumes no responsibility for errors or omissions.
5 TABLE OF CONTENTS 1 - INTRODUTION POSTER PRESENTATIONS COMMUNITY NURSING 12 Calouste Gulbenkian Nursing Scholl of Lisbon and the Local Administration Alcochete s and Seixal s communities A Partnership Experience Talking in neighbourhoods A (collective) Feeling on approach to Alcochete s and Seixal s communities The Population Functioning and Social Weaknesses in Community A (collective) feeling on approach to Alcochete s and Seixal s communities Health Education and Nursing Care in Integrated Continuous Care: A Literature Review NURSING HISTORY 21 Calouste Gulbenkian Nursing School of Lisbon in 90 s: A look into the Past Evolution care and healthcare in Portugal From 13 th Century to 20 th Century The Mission and Action of the Portuguese military nurses in the course of the Independence War (from 1640 to 1668) Nurses and Midwives in Portugal: Training/Education from XIX to XX Century Ethel Fenwick: the woman who had a dream Renaissance, Protestant Reformation and the Decadence of Nursing (1500 to 1700) St. Vicent de Paul Escola Técnica de Enfermeiras (Learning to teach) Kaiserswerth Institute s Superintendents: Matriarchs of Modern Nursing GENERAL NURSING 39 Nurses satisfaction with regard to the intrinsic characteristics of the nursing working methods Using ICNP to describe self care deficit due to inability to perform self-hygiene Developing an ICNP catalogue to promote comfort in nursing practice: complexity vs. pragmatism Spiritual Nursing Care to Relief Suffering in Haemato-Oncology Patients Needs of Involvement of Health services in people with pain and economic, social impact: A systematic review of literature ADULT AND CRITICAL NURSING 51 The Person in a Post CVA Situation: The nurse's intervention over the process of rehabilitation and reintegration into the community with hospitalized clients The Patient with Chronic Heart Failure: Transition in Self-care and Quality of Life Intensive Care Unit: a nursing profession gateway? CARE: an Emergency at the Emergency Department How can I, person with chronic illness help you, nurse, to take care of me? The know-how of person with chronic illness The importance of nursing intervention in the promotion of HIV/AIDS patient s compliance to antiretroviric therapy
6 The Nurse as a promoter of inclusion and empowerment of the family in the management of chronic disease Caring for a Person with stroke... Prevention of spastic pattern How is Quality of Life in patients with Rheumatoid Arthritis - Contributions for nursing ELDERLY NURSING 71 Promotion of self-care to the person dependent on nursing care Preparing the home return, of the elderly person, after fracture of the proximal end of the femur Preparing the Family Caregiver of the Adult / Elder Dependent Person on Self Care Hygiene in the Transition from Hospital to Home The Elderly Person with Dementia Abused by the Family: partnership as a Nursing Intervention to Promote the Care of the Self Dyspnoea Assessment as a Nursing Intervention: Facilitating Therapeutic Regime Management in Elderly Patients with COPD Assessment of the risk of falls in elderly patients admitted in a Medical ward Elderly Falls Prevention in Nursing Home Context An Intervention Project CHILD HEALTH AND PEDIATRIC NURSING 85 Adolescents and health care providers in a health service for adolescents: What they say about it? Play activities during hospitalization A way of caring the children with chronic illness Play in Nursing Education: From Project to Practice An Optional Course in Nursing Degree: The Child and Play Activity Scientific Evidence in Nursing Care Evaluating the effectiveness of non-pharmacological strategies for pain relief in Paediatrics: A meta-analysis Sting Does Hurt Representations of pain in children of school age, who underwent venipuncture The early feeding skills during the introduction of oral feeding on preterm infants: Prevalidation study and determination of feeding skills Child injuries at home- Prevention, Precautions and Intervention with focus on scalds The Development of Autonomy in Young Patients with Spina Bifida: What do the youngsters and their parents/careers say The quality of life of the children with heart disease Systematic Revision of Literature Parenting and Transition in Chronic Illness Thinking about the contribution of nursing Nursing skills valorised by children with chronic illness and their families inside a hospital Indicators and tools for assessment of body composition A Practical experience Children Obesity and the Overweight Assessment A critical perspective of nursing practices Childhood obesity - Somatotypology Methods of Assessing Body Composition A magic cube to magic children Project of a toy adapted to blind children Children's Playing in the Park: Observation of the Quality of Play Teddy nursing: A different way to approach health to children Learning with Kiko and Tobias: A learning game for children with Spina Bifida WOMAN CARE NURSINH AND MIDWIFERY 125 Smoking during pregnancy: knowledge, attitudes and practice of gynaecologists and midwives in Flanders, Belgium Discharge procedures from the delivery room
7 When preventing is an option Early detection behaviours and breast cancer perceptions of ESEL women (2008) The desire of having a child: The experience of the infertile couple A Path through Infertility All for a Child: The implications of the diagnosis and treatment of infertility NURSING EDUCATION 137 Feedback in clinical nursing education: Tutors use and students perceptions Portfolio as a tool for professional development: Proposal to use it for the integration of a new clinical teacher and preliminary results Reflective-practice in nursing student s Clinical practice: contributions to the structuring of thought The challenge of cultural diversity: The Project of Nursing Education of Foreign Nurses Theoretical perspective in use by approved Swedish clinical nursing supervisors International project focused on the quality of education - Empowering the Professionalization of Nurses through Mentorship (EmpNURS) MENTAL HEALTH NURSING 151 The meaning of mental illness and emotional skills of nursing students Problems of ageism in view of paramedical healthworkers at Departments of Psychiatry ORAL COMMUNICATIONS Professional qualifications directive: implications to nursing education PALIATIVE CARE NURSING 163 Caring in the last days of life: Experiences of nursing students during clinical practices Outcomes from non-conventional therapies in nursing practice HOW CAN SCHOOLS OF NURSING CO-OPERATE WITH LOCAL AND INTERNATIONAL COMMUNITIES IN HEALTH PROMOTION AND EMPOWERMENT? (ESEL PROJECTS) 169 Dealing with emergency situations: empowering Cova da Moura neighbourhood residents Co-operation with a Cape Verde University to improve the quality of nursing education Flying South, Nursing in Portuguese DIFFERENT PARADIGMS IN MIDWIFERY EDUCATION 177 The Portuguese Perspective The Belgium Perspective PARTNERSHIPS IN CHILDREN S NURSING EDUCATION 183 Mentoring ESEL and Erasmus Students in Clinical Practice Research partnerships: Early Feeding Skills Scale Validation, FINAL COMMENTS
9 1 - INTRODUTION Dear Colleague, For a number of years members of the Florence Network for Nursing and Midwifery have discussed introducing a more academic approach within the annual meetings. I'm pleased to write this introduction to the book of abstracts produced by the organisers at ESEL and with contributions from members. I hope that this will become a regular feature of the meetings and one that will strengthen and grow over the years. Of course, introducing this approach does not mean that we will abandon our existing approaches the warmth and welcoming relationships are a hallmark of the network and one of the reasons we have sustained, broadened and deepened the network over such a long period. My thanks go to the organisers and the contributors, my wishes are that we all make good contributions next year and I look forward to welcoming and meeting you all in Lisbon. Best wishes Andy Gibbs 9
10 Dear Colleagues, The Florence Network is an international co-operation in Nursing and Midwifery at Higher Education, Polytechnic and University level, established with educational, scientific and pedagogical aims. The Florence Network guarantees to respect the different ideologies, strategies and visions used in Nursing and Midwifery education across Europe. The objective of the Florence Network is to develop and increase the quality of higher education in Nursing, Midwifery and health care by means of international co-operation in the field of education, scientific research and development. In this way the organisation tries to improve the image of the profession and to raise the profile of Nursing and Midwifery within Europe (Regulations of the Florence Network, 2010). Developing and increasing the quality and the image of Nursing and Midwifery education requires a research approach. The initiative of introducing a scientific poster contest during the 19 th Annual Meeting of the Florence Network was an attempt to increase the habits of sharing research, even though the posters exhibition might include different levels of research studies, from different schools, countries and, of course, representing different paradigms. Some posters result from doctoral programs, others are the first steps from pre-graduation thesis, others are somewhere in between. So, there is a great diversity. Nevertheless, we choose to try and expect your input and evaluation. The idea of creating this ebook arose when the number of posters accepted became so big that we understood that seeing them for such short periods, has was previously determined, wouldn t be enough to choose the one to vote for. It would be useful to have access to the abstracts Then, we thought, why not include the conferences abstracts too? The result was this ebook that, we expect, can be a useful tool to select the best abstract, and, maybe, represent one more step to create some research networks among Florence Network partners. Be welcome in Lisbon, Mª Teresa Leal
11 2 - POSTER PRESENTATIONS 11
12 2.1 - COMMUNITY NURSING
13 CALOUSTE GULBENKIAN NURSING SCHOLL OF LISBON AND THE LOCAL ADMINISTRATION ALCOCHETE S AND SEIXAL S COMMUNITIES A PARTNERSHIP EXPERIENCE Authors: Claudia Mariana Julião Bacatum, RN, Lecturer Maria Alice dos Santos Curado, RN, Professor Maria Emilia Campos de Brito, RN, Lecturer Lina Maria Antunes, Lecturer Lucia de Lemos Vaz Velho, RN, Professor Maria Odete Matos Pereira, RN, Professor Viriato Moreira, RN, Professor Students of the 8th CLE ESECGL Escola Superior de Enfermagem de Lisboa Portugal POSTER ABSTRACT: 1 13
14 The Nursing Degree is based on assumptions that recognize nursing as an autonomous profession with a framework and a scientific methodology itself. In this context the knowledge of nursing is developed with a integrate view of health and disease, in which health is a resource for life, a positive concept, a route along which the individual/group, which appears in its ecological environment, can be realized through the satisfaction of their needs. Considering person as an open and dynamic system, that interacts with itself, with others and with the environment, making choices according to the meaning of each situation and recognizes that the therapeutic projects are established in partnership. This project involves several players such as social partners and ordinary people who shared a collecting and information experience in Alcochete s and Seixal s communities in a clinical practice setting. We proposed to the nursing students for the 1st year to develop scientific, technical, social, cultural and psychological skills for the practice and management of nursing care to the person, family, groups and communities. The student must attend the training in nursing and other related areas to develop continuity in the teaching/learning process. This acquisition of knowledge requires students to focus on our clinical training settings in accordance with criteria of continuity and innovation, enhancing existing partnerships and past experiences; the conditions of the units and the contexts of practice, but without neglecting the establishment of new partnerships. Aim: Identify social and health determinants and to develop the sharing and reflection about the nursing practice. Methodology: Develop inter-institutional meetings to know the goals, the conditions and the needs of all partners. Nursing empiric research tools connected with health, social and human s sciences were given to enhance the learning process. We have done an exploratory study, with a quantitative and qualitative approach. A questionnaire survey were applied to 1000 participants (Alcochete, n=715 and Seixal, n=285) and an observational guide was used. Results: We identified social determinants that affect the communities health, and promoted the relationship with the partners and their institutions. The network of social resources seemed to us diverse, although it is not possible for us to affirm that it is sufficient to meet the needs of the population in each county. Conclusions: With this experience it was possible to identify the social determinants that affect the communities health. This interaction in these two communities and the reflexion of nursing practices, in the global and health policies, enhanced the student s awareness of good citizenship. Along this project of partnerships the involvement of the new participants, allowed us to create a larger space for sharing and reflection on the practices with those involved. Key words: partnership, nursing, community, social-determinants, health-determinants Bibliography: Câmara Municipal do Seixal (2006), Diagnóstico Social do Concelho do Seixal, Gabinete de Acção social Seixal Rede Social, documento policopiado. Documento de Planeamento do 8º Curso de Licenciatura em Enfermagem, ESEnfCGL, Outubro Lindsey, Elizabeth; Sheilds, Laurene; Stajduhar, Kelli (1999), Creating effective nursing partnerships: relating community development to participatory action research, Journal of Advanced Nursing, Vol. 29, nº. 5, p St. John, Winsome; Keleher, Helen (2006), Community Nursing Practice Theory, skills and issues, Crows Nest, Allen & Unwin. Vollman, Ardene Robinson; Anderson, Elizabeth T.; McFarlane, Judith M. (2007), Canadian Community as Partner: Theory & Multidisciplinary Practice, Philadelphia, Lippincott William & Wilkins.
15 TALKING IN NEIGHBOURHOODS A (COLLECTIVE) FEELING ON APPROACH TO ALCOCHETE S AND SEIXAL S COMMUNITIES Authors: Lina Maria Antunes, Lecturer Maria Alice dos Santos Curado, RN, Professor Claudia Mariana Julião Bacatum, RN, Lecturer Maria Emilia Campos de Brito, RN, Lecturer Lúcia de Lemos Vaz Velho, RN, Professor Maria Odete Matos Pereira, RN, Professor Viriato Moreira, RN, Professor Students of the 8th CLE ESECGL Escola Superior de Enfermagem de Lisboa Portugal POSTER ABSTRACT: 2 15
16 Introduction: The concept of space assumes importance in the interpretation that leaders have of the contexts under observation (Alcochete and Seixal), concerning the sociality, historicity and spatiality. We based our approach in the relationship between the leader/participant with the territory, and he/her own actions in this construction. The leader gives meaning to social logics, according to the geographical existence. The Aim of this work are to interpret the intentional relationship that individuals have with the territorial contexts that structure their action and how the world built induces the construction of a value system, which determines interpretation of the phenomena. Methodology: An exploratory study with a quantitative approach. We administered a questionnaire survey of 50 participants in the municipality of Alcochete and 33 in Seixal. Results: We perceive from the two contexts that identities mobilize themselves in domination situations with asymmetric relations within spaces of power. The affiliation of each participant comes from a process of identification or belonging recognition. These processes refer to the practice and the collective imagination, associating certain groups attributes with whom they identifies. Conclusions: The construction of identity images of the contexts and their population converge in ways of living and specially the ways of expressing those social territories. Key words: dynamic, social, health, nursing, identities and interactions Bibliography: Câmara Municipal do Seixal (2006), Diagnóstico Social do Concelho do Seixal, Gabinete de Acção social Seixal Rede Social, documento policopiado. Dubar, Claude (1991), La Socialisation. Construction des Identités Sociales e Profissionnelles, Paris, Armand Colin. Freitas, Mª João (2001), Recentramento do olhar nas questões da habitação, Cidades, Comunidades e Territórios, n.º 3, pp Guerra, Isabel (1997), Um olhar sociológico sobre o alojamento, Sociologia Problemas e Práticas, n.º 24, pp Pinto, José Madureira (1991), Considerações sobre a produção social de identidade, Revista Crítica de Ciências Sociais, n.º. 32, pp Silva, Ana M. Santos (1999), Os constrangimentos de política de habitação em Portugal, texto policopiado, Lisboa,B.N..
17 THE POPULATION FUNCTIONING AND SOCIAL WEAKNESSES IN COMMUNITY A (COLLECTIVE) FEELING ON APPROACH TO ALCOCHETE S AND SEIXAL S COMMUNITIES Authors: Maria Emilia Campos de Brito, RN, Lecturer Maria Alice dos Santos Curado, RN, Professor Lina Maria Antunes, Lecturer Claudia Mariana Julião Bacatum, RN, Lecturer Lúcia de Lemos Vaz Velho, RN, Professor Maria Odete Matos Pereira, RN, Professor Viriato Moreira, RN, Professor Students of the 8th CLE ESECGL Escola Superior de Enfermagem de Lisboa Portugal POSTER ABSTRACT: 3 17
18 INTRODUCTION: Health and vulnerability in life expresses its self in several ways in the different social groups. We want to recognize the life conditions of Alcochete s and Seixal s communities, responsible for most of the differences of person and communities health status. The AIM of this study is: identify participant s concepts of dependency and disability. METHODOLOGY: Exploratory study with quantitative approach. We administered a questionnaire survey to the participants in the communities of Alcochete (n=715) and Seixal (n=285). For analysis we used the International Classification of Functioning, Disability and Health (ICF) (WHO 2004). RESULTS: We recognized weaknesses in those areas: body functions, activities and participation with consequent influences regarding the functioning and disability. And we founded 92 situations of dependency and disability in Alcochete and 45 in Seixal. CONCLUSIONS: Based in the ICF in which the deficiencies could be a part or an expression of health condition, but not necessarily a disease. These data were relevant to the planning of emergence and catastrophe response in those communities. Key-words: health, nursing, social weaknesses, functioning, dependency/disability Bibliography: Câmara Municipal do Seixal (2006), Diagnóstico Social do Concelho do Seixal, Gabinete de Acção social Seixal Rede Social, documenta policopiado. Documento de Planeamento do 8º Curso de Licenciatura em Enfermagem, ESEnfCGL, Outubro World Health Organization (2001), International Classification of Functioning, Disability and Health, Geneve, WHO. Stanhope, Marcia; Lancaster, Jeanette (1999), Enfermagem comunitária: promoção da saúde de grupos, famílias e Indivíduos, 4ªed., Lisboa, Lusociência. St. John, Winsome; Keleher, Helen (2006), Community Nursing Practice Theory, skills and issues, Crows Nest, Allen & Unwin.
19 HEALTH EDUCATION AND NURSING CARE IN INTEGRATED CONTINUOUS CARE: A LITERATURE REVIEW Authors: Pedro Lucas Nursing Lecturer, Escola Superior de Enfermagem de Lisboa Gisela Teixeira RN, Centro Social Paroquial, Nossa Senhora do Livramento Bárbara Vieira RN, Santa Casa da Misericórdia, Chamusca POSTER ABSTRACT: 4 19
20 In 2008 and 2009, one of the foremost motives of referrals to Integrated Continuous Care Units and Community Care Teams of the National Network for Integrated Continuous Care (RNCCI) was the need to educate the patient and/or caregiver. In this context, this studies aim was to describe the manner in which Health Care Education relates to the Network and in which way it relates to patient results and nursing care. For the consecution of this paper the chosen methodology was a literature review, begun in October of 2010, which compiled 94 documents, including compositions, investigation studies, thesis s, reports and web sites. Throughout this study it was thrown into relief that Health Education is related to the end purpose of the RNCCI sharing with it guiding principles and goals; it enhances and promotes self-care; the ability for therapeutic self-care is related to the performance of nursing functions, being that Health Education is one of the main nursing interventions that contribute to this result. Health Education has a vast range of intervention in enabling and making individuals accountable for their health, indubitably being an autonomous nursing intervention and an integrating part of the process of nursing care outcomes, results and gains in health for the population. As a nursing care intervention, it is possible to empower individuals and caregivers with capacity, autonomy, more independence and, therefore improving the quality of life. Key-words: Health Promotion; Health Education; Nursing care; National Network for Integrated Continued Care Main References: DORAN, Diane; [et al] Relationship between Nursing Interventions and Outcome Achievement in Acute Care Settings. In: Research in Nursing & Health. Nº p TONES, K.; TILFORD, S. Health education. Effectiveness, efficiency and equity. London: Chapman & Hall Unidade de Missão para os Cuidados Continuados Integrados Orientações Gerais de Abordagem Multidisciplinar e Humanização em Cuidados Continuados Integrados. Lisboa: Unidade de Missão para os Cuidados Continuados Integrados, Março 2007.
21 2.2 - NURSING HISTORY 21
23 CALOUSTE GULBENKIAN NURSING SCHOOL OF LISBON IN 90 S: A LOOK INTO THE PAST Authors: Claudia Mariana Julião Bacatum, RN, Lecturer Maria Alice dos Santos Curado, RN, Professor Miguel Joaquim Nunes Serra, RN, Lecturer Maria Isabel Costa Malheiro, RN, Lecturer Escola Superior de Enfermagem de Lisboa POSTER ABSTRACT: 5 23
24 Introduction: The Calouste Gulbenkian Nursing School of Lisbon, established in 1957 under the name Hospital de Santa Maria College of Nursing, was for nearly 50 years, a major reference in Portuguese nursing, on educating and training about 5000 nurses. In the 90 s, the inclusion of Nursing Education on the Portuguese polytechnic education system provided a new audience and new expectations for the school community, increasing technical and scientific demands for teachers and students. On addition, professional status became more prestigious. Simultaneously, we assisted to an investment in higher education, first in Graduate Diploma and then in Masters and PhD. The aim is to describe the historical development of the Calouste Gulbenkian Nursing School of Lisbon, since the integration in Higher Education (1990), until the merge with others public schools in Nursing School of Lisbon (2007). Methodology: Exploratory study with a qualitative approach. Data were collect by six semi-structured interviews (teachers and stakeholders) and by analysis and interpretation of different kind of documents: school archives and legislation. We analyzed different dimensions of school s life, particularly in terms of their response to social changes, legislation and how these responses are reflected in its dynamic organization, offering training, resource development, external relations and the production and dissemination of knowledge. Findings: We found that the new curriculum includes not only the technical and training dimension but also scientific and cultural ones. The studies are developed in 6 semesters, 108 weeks, total of 3300 hours (theory h/46%; training h/54%). With the Bachelor Nursing Degree the students had nursing competences to provide basic nursing cares to persons, families and communities under the 3 levels of prevention and also have basic skills to collaborate in the nursing care management Conclusion: These changes were more than the school s name, it represented a profound revolution in the way school actors identify their selves. The nursing education curriculum as changed from a patients biomedical approach to an approach based on the contemporary nursing paradigm. Key words: History; Nursing-School; Higher-Education Bibliography: Amendoeira, José (2006), Uma biografia partilhada da enfermagem, Coimbra, Formasau. Soares, I. (1997), Da blusa de brim à touca branca, Contributo para a história do ensino de Enfermagem em Portugal ( ). Lisboa, Educa e Associação Portuguesa de Enfermeiros. Sources: Legislation from seventies to nineties Nursing Schools Archives
25 EVOLUTION CARE AND HEALTHCARE IN PORTUGAL FROM 13 TH CENTURY TO 20 TH CENTURY Authors: Maria Alice dos Santos Curado, RN, Professor Marília Pais Viterbo de Freitas, RN, Professor Maria Isabel Soares, RN, Professor Escola Superior de Enfermagem de Lisboa Portugal POSTER ABSTRACT: 6 25
26 The Purpose: Is to show what Portuguese nurses have done in the past until now and to understand future nurse competences and share the evolution care and healthcare in Portugal from 13 th Century to 20 th Century. Methodology: Is supported in analyses and interpretation of different kind of documents: Official Papers, Manuals, Hospital Regulations and professional papers. Findings: From the 13 th to 15 th Centuries, care is done by the monastic orders that take care of travellers and patients. There were also small hospitals organized by rich people or by workers. Only poor people go to the hospitals; the families that could pay have home care. At the 15 th Century King John the second starts to build the Hospital de Todos-os-Santos and Queen Leonor creates the Charitable Institution both of them in Lisbon. These Charity Institutions were developed all over the country. Caring is done by nurses (men and women) and by midwifes (only women). All of them learn from each other because nursing and midwifery education doesn t exist at the time. Their competences were established on the Hospital Regulations and on the Manuals. Only the midwifes have to do an official examination since 16 th century. Since 1949 the nurse s career in the hospitals were regulated by law. This law changes almost twenty years later in 1967 including for the first time the three areas of nurses intervention, practice care in hospital, in community care and nursing education. During more than 100 years the nurses and midwifes education changed not only because of the science evolution but also because of the study and engagement of these professionals. At the end of 19 th Century (1895) the midwifes create their first professional organization and the nurses create their first Trade Unions in the beginning of the 20 th Century (1926). During more than 100 years, nurses and midwifery s education changed not only because of the science evolution but also because of the study and engagement of these professionals. Finally in 1998 was created the Nurses Order. The nursing career changed in different occasions. Conclusions: From the thirteenth to the nineteenth century nursing care didn t suffer a major evolution. The political and social changes that occurred in 1975 had a decisive influence on the development of the education, profession and working conditions of nurses. The development of quality of care was due to the organization of the National Health Service in 1976, but also and specially by the commitment of nurses in different areas of practice care. From the nineteenths, with the beginning of scientific training of midwives and nurses, nursing care began to respond to the needs of the population and in the nineteenth century the first professional organization was created. Keywords: nursing, midwives, training, profession, history. BIBLIOGRAPHY: Bombarda, Miguel Enfermeiras Religiosas, in A Medicina Contemporânea, Ano XVIII, nº 21, 22, 24. Série II Tomo III, 3, 17, 27 de Julho Cardeira, L. da Silva As Irmãs de Caridade nos Hospitais, in Jornal da Sociedade das Ciências Médicas, Tomo XXII, Junho, 1858, p Carvalho, A. da Silva Subsídios para a História das Parteiras Portuguesas, Medicina Contemporânea, nº 29, 1931, pp Marques, A. H. Oliveira História de Portugal. Lisboa: Palas Editores, 1973, 2º Vol. SOURCES: Legislation from 1837 to 2001 Hospital Archives National Archives Torre do Tombo