Nurses, philanthropies, and governments: The public mission of Chilean nursing 1900–1945

Abstract

This dissertation examines the role of nurses in Chile during the transformation of the health care system from charitable benevolence to duty of the state. The first secular nurses trained to assist physicians in 1902 and were educated, middle class women. The Constitution of 1925 made public health a state responsibility and created a middle class bureaucracy. A U.S. model of public health nursing started in Chile in 1927. In 1941, the International Health Division of the Rockefeller Foundation was invited to improve public health and to build the public health leadership of physicians and nurses in Chile. A demonstration health clinic employed public health nurses to do home visiting and preventive patient education, and became a successful model and teaching center for public health nurses. During the 1930s and 1940s, nurses began to teach, direct schools, supervise their profession and organized a professional organization. The study questions examined are: (1) Did the work of public health nurses change with each new presidential administration elected into office 1927 and 1945? (2) Did the Rockefeller Foundation nurse consultants propose a program of nursing service that would radically transform public health practice in Chile? (3) Did U.S. influence transform the professional status of nurses and their role in the health care system of Chile? Primary and secondary sources in English and Spanish were analyzed using a social history framework. Primary documents were obtained from the Rockefeller Archive Center, el Colegio de Enfermeras de Chile, and la Biblioteca Nacional de Chile. As Chilean nursing developed, government support influenced the work of public health nurses through selective funding for programs and nursing education. The Rockefeller Foundation nurses introduced ideas that changed Chilean public health by introducing patient education and patient responsibility for health. The Chilean nurse leaders improved their professional status with the International Health Division's influence through the promotion of higher education and with backing to introduce changes to advance Chile's nursing profession.