Mary Frances Crowley: Vision, Values and Principles still alive and flourishing?

Summary: Mary Frances Crowley nurse, midwife and nurse and midwifery tutor was founder member and first Dean of the Faculty of Nursing and Midwifery in the Royal College of Surgeons in Ireland. She started the Medical Missionaries Midwifery Training School at the International Hospital, Drogheda in 1942. She was a visionary who was instrumental in the development of education and professional development for nurses and midwives in Ireland. She lived and worked by her values and principles and expected others to do likewise.

Background: A Faculty of Nursing of the RCSI was a vision Miss Crowley nurtured for many years until its fruition in 1974. The Faculty was her creation, offering studies at the highest level of professional and academic excellence for nurses, when few colleges had yet to start introducing programmes for nurses. The Faculty is recorded as a milestone in the development of Irish nursing due to her foresight and dedication to early nursing education and in promoting ethical principles.

Aim: The Commentary to the Editor seeks to obtain the views of scholars in relation to the content presented here. The commentary provides insights into the life and legacy of Mary Frances Crowley a forward thinking nurse, midwife and inspiring leader whose nursing career was governed by Christian values.

Research Methods: This literature review undertaken in 2016, explores the work and writings of Miss Crowley. Searches were undertaken in archives and libraries in the Royal College of Surgeons in Ireland and in hospitals where she worked.

Implications for nursing: This study highlights how nurses’ of vision, holding ethical values aimed at providing care that enshrines responsibility for professional conduct. Findings will inspire patients with hope, confidence, and awareness of their individual potential through their own efforts.

Introduction and Background

Mary Frances Crowley (1906-1990), Founder Member and first Dean of the Faculty of Nursing and Midwifery, Royal College of Surgeons in Ireland, was born in Wexford, Republic of Ireland. She was educated initially in a convent in Wexford and later by tutors. This education in several schools was followed by the King’s College Cambridge Entrance Course under tutors. She qualified as a nurse and midwife in the United Kingdom. Miss Crowley established, in 1980, a Nursing History Museum in the Faculty of Nursing, RCSI.

Miss Crowley believed that each nurse is professionally responsible for professional conduct, advanced knowledge, and civic responsibility and that nurses’ of vision are needed, who will inspire patients with hope, confidence, and awareness of their individual potential through their own efforts and by a nursing service that is dedicated to an ideal of Christian values. She lived by these ideals never wavering from them, never displaying any unreasonableness to any other faith or creed. She demonstrated respect for voluntary carers of the intellectually disabled, elderly and mentally ill, in Ireland, through her own involvement in voluntary organizations and by meeting with such groups [1].

Miss Crowley displayed foresight in her words relating to the use of technology in healthcare delivery saying that “Technological progress modifies our picture of the world, thinking, acting and human relationships take on new aspects and concepts, especially in the fields of health and well- being, often to the exclusion of ethical standards which are unchangeable.”(1 p 12). She was also progressive in her view of the nurse saying that “the role of the modern nurse as a contributor has extended from the bed side into the preventive field to the home, community and school, not only as learners but also as advisors, coordinators, administrators and educators, so education must extend to preparation for the new role demanded by society” (1p 13). Only nurses can determine the boundaries of nursing, its requirements and the preparation required. Only nurses can establish the proper task of the nurse, the image of the nurse at the bedside remains, and in addition the modern nurse has entered into the field of preventive medicine and rehabilitation and she is the person best suited to extend hospital services into the community [1].

Research Methods

This literature review undertaken between April-October 2016, explores the work and writings of Miss Crowley. Searches were undertaken in archives and libraries in the Royal College of Surgeons in Ireland and in hospitals where she worked. The research approach adopted drew on a scoping review methodology. This approach was selected as the most suitable method for this study because, by definition, it is used ‘to map rapidly the key concepts underpinning a research area and the main sources and types of evidence available, and can be undertaken as stand-alone projects in their own right, especially where an area is complex or has not been reviewed comprehensively before’ [2]. The extent, range and nature of research activity relevant to the work undertaken by Miss Crowley were considered.

The review followed these steps

1. Identifying the aim of the study

2. Identifying the key questions

3. Identifying topic-relevant studies, RCSI and hospital papers

4. Selecting studies using a set of inclusion criteria

5. Reviewing the sorted and sifted data through the identification of key themes

6. Analysing the results through thematic analysis and reporting findings descriptively

A literature search was undertaken across CINAHL [1940-1990]. Secondary sources were also identified from references in papers and documents. Due to the nature of the topic the searches were broad. The search yielded a small number of publications: CINAHL (35) using relevant search terms and 45 publication identified in hospital, RCSI and school libraries. Study titles and abstracts were reviewed by two reviewers and assessed for relevance. Abstracts were discussed by the two reviewers if the relevance to the review was unclear. Reference lists from papers were manually searched for additional material. All papers considered to be relevant by the reviewers were considered. Faculty documents were searched. The aim of the Faculty was and continues to provide nurses’ with the opportunity to become continuous learners in order to benefit society. The Faculty documents 1974-1986 outlined Faculty of Nursing objectives as emphasising proficiency in professional practice including promotion of health and wellbeing through continued learning programmes for registered nurses.

Discussion

Nursing and midwifery career

Miss Crowley travelled to Britain to pursue her nursing career as many Irish women of her era did. On achieving her State Registered Nurse Certificate, in 1935, in Chester City Hospital, United Kingdom and her State Registered Midwifery Certificate in 1936, in St Catherine’s Hospital, Birkenhead, a Midwife Teacher’s Course in Birkenhead and Merseyside Maternity Hospitals and Mile End Hospital London followed. From 1936-1940 she obtained wide clinical experience in these training hospitals as Staff Nurse, Surgical, Medical unit Sister, Night Sister, Maternity Unit Sister and Pupil Midwife Teacher.

She was registered as a nurse in Ireland in 1941 when she returned as Administrative Sister (Home Sister) to Sir Patrick Dun’s Hospital, Grand Canal Street, Dublin. Miss Crowley started the Medical Missionaries Midwifery Training School in Drogheda, Co. Louth in 1942. In April 1990, Sister Immaculata Nichols, Foundation member of the Medical Missionary of Mary, in her tribute to Ms Crowley asks if many people know that it was Mary Frances Crowley who started the Medical Missionaries Midwifery Training School at the International Hospital, Drogheda in 1942. Her admiration for Mother Mary, founder of the Medical Missionaries of Mary inspired her to offer her skilled services to start the nucleus of a Midwifery Training School in Drogheda- affiliated with the National Maternity Hospital, Holles Street, Dublin…” [3].

In June 1944, Miss Crowley was appointed Assistant Matron of the Royal Victoria Eye and Ear Hospital, Dublin, where she remained for the next 46 years. In 1947, she founded the Nursing Training School in this hospital and became Director of Nursing Studies. Subsequently she obtained the Ophthalmic Nursing Diploma, Nurse Tutor’s Diploma and Certificates in Hospital Administration and Management, Sociology, Examination Procedure and Examination Assessment. She founded the first twelve month, post-registration clinical specialisation course in Ophthalmology for nurses in 1948, which extended in 1950 to Moorfield’s Hospital, London becoming the Ophthalmic Nursing Board Certificate of Great Britain and Ireland: recognised as an International qualification [2]. This programme continued until 1987 when a decision was made to continue the course under the auspices of An Bord Altranais, the Nursing Board of Ireland. During this time she acted as Nurse Examiner for state examinations for An Bord Altranais and lectured at the Faculty of Nursing, Royal College of Surgeons in Ireland. She also undertook international work during this time [4], as well as voluntary service as a member of several societies. Combining her warmth and unique leadership skills set her apart as an influential leader with vision who possessed excellent organisational and diplomatic skills, all evident in her remarkable contribution to nursing management in Ireland and internationally.

Continuing nursing education: irish red cross hospital, saint-lo, france

In December 1945, Ireland and the Irish Red Cross equipped, presented and staffed the city of Saint –Lo, France with the gift of a fully equipped hospital of over 100 beds and Miss Crowley was appointed Matron-in –Charge of the Irish Red Cross Hospital in Saint-Lo from 1945-1947 [5]. On arriving in Normandy the hospital group were met by Samuel Beckett, later to become the noted writer, who had the role of driver, store keeper and interpreter. Dr. Eoin O’Brien in his article “Samuel Beckett at Saint-Lo, writes that the medical, nursing and administrative staff is all Irish and it was acknowledged that the success of this work was attributed in no small measure to Miss Crowley [6]. Miss Crowley remained as Matron of L’Hospital Irlandais de Saint-Lo” until it was handed over as a fully functioning hospital to the French Red Cross in December 1946 [5]. On the occasion of the 25th Anniversary of the Allied Landings on the Normandy Beaches, the French Government expressed its gratitude to Miss Crowley and the staff by awarding them the “Medaille de la Reconnaisance Francaise” [7]. In a letter sent by Henri Liebard on 20th February 1971, from Le Maire de La Ville, Ville Dr Saint-Lo, Chevalier de la Legion d’Honneur to M. F. Crowley, he said that it was decided to award Miss Crowley with the Medal of Honour in commemoration of her work in the hospital at that time [8].

Character and philosophical values as outlined by m f crowley

Miss Crowley held Christian values which she maintained throughout her life. She acknowledged the inherent qualities in the voluntary principles of caring and as a result she was often intolerant of aspects of health systems which she believed placed over emphasis on organised state services to the exclusion of the traditional values of voluntary concern and caring , saying that “Nursing is above all a vocation.” (4 p 10). She exhibited respect for the voluntary carers of the intellectually disabled, elderly and mentally ill in Ireland through her own involvement in voluntary organisations and by meeting with such groups of individuals. Although she admired the voluntary and home caring of such groups she advocated for a balance between voluntary caring services and agencies and state funded services which she promoted through emphasis on development of state policy. She believed the State had a role in funding organisations for the groups she supported, particularly in the community. She emphasised safeguarding and promoting the best of traditional values of rural Ireland of caring for the sick and underprivileged, when speaking to students and nurses’ alike [9]. Mr. McAuliffe –Curtin, President of RCSI, In his address to the Annual Meeting of Foundation Members of the Faculty of Nursing in 1990, spoke of the stamp of efficiency and professionalism provided by Miss Crowley and on how she continues to give generously of herself saying “she upheld her Christian principles and never wavered from them; never displaying any unreasonableness to any other faith or creed” [1]. This sense of selflessness and devotion to others of different faiths was evident in her work and in her writings.

Nurses’ character as outlined by m f crowley

Miss Crowley described the nurses’ character as being modelled on principles. These principles included having knowledge and understanding of human frailties needed to fulfil the responsibilities of modern nursing, that involves the physical mental and spiritual well- being of her patients. To treat one aspect without consideration of all three is totally inadequate and a danger to the patient and a hazard to society [10]. Those principles and values remain and are embedded in Codes of Practice for professional nurses and midwives in many countries, including Ireland [11]. She promoted the notion that nurses’ need to have experience of all age groups and cultural interrelationships in order to be fully responsible to those who come under their care: views remaining to the fore in patient care. Nurses also need vision, she said, to inspire patients with hope, confidence, and awareness of their individual potential through their own efforts. Miss Crowley advocates a “listen and learn” approach to nursing care that has moral principles at its core. She believed that to reach the kernel of a sick society the nurse must be responsible to society by accountability of her vocation and continuous learning and that each nurse is professionally responsible for professional conduct, advanced knowledge, and civic responsibility. This forward thinking is now termed continuous professional development [10].

The nurses’ role as presented by m f crowley

Miss Crowley in her paper “Towards a healthy society” in April 1979, says that the role of the nurse is significant in this theme since society is made up of people, each one unique and having individual and definite responsibility, serving society with the same objective of a healthy society. Health preservation is not sickness orientated and technological innovations influence every aspect of our existence: biological, societal, cultural, demographic and economic. As increased life expectancy upsets relationships in the density of populations the ratio between young and aged produces new economic and social responsibilities. Technological progress modifies our picture of the world, thinking, acting and consequently human relationships take on new aspects and concepts, especially in the fields of health and well- being, often to the exclusion of ethical standards which in her view are unchangeable [12].

The role of the modern nurse as a contributor has extended from the bed side into the preventive field to the home, community and school not only as learners but also as advisors, coordinators, administrators and educators, so education must extend to preparation for the new role demanded by society. In addressing students in Cavan in Nov 1978, Miss Crowley in speaking about continuing education programmes, on a new medical ethics programme being introduced in the Royal College of Surgeons, said that ethics is a basic science and there must be a balance between good and evil because each profession has its own standards and expects its members to adhere to them [10].

Formation of faculty of nursing (1974-1990)

With a small group of committed fellow nurses and Mr. John McAuliffe Curtin, President, Royal College of Surgeons in Ireland, Miss Crowley founded the Faculty of Nursing in the Royal College of Surgeons in Ireland. Midwifery was added to the title in 1990. A Faculty of Nursing of the RCSI was a vision Miss Crowley nurtured for many years until its fruition in 1974. The Faculty was her creation, offering studies at the highest level of professional and academic excellence for nurses [9]. She travelled throughout Ireland establishing centres of excellence for the training of nurses, the first of which was in St. Senan’s Hospital, Enniscorthy, Co. Wexford, the county of her birth [9,13,14]. Miss Crowley gave the nursing profession something unique in the development of the Faculty of Nursing, She saw the need for nurses to study the sociological, anthropological and spiritual aspects of human endeavour as an integral part of nurse education. She enshrined this philosophy in the Faculty of Nursing courses and gave practical effect to her idea [9]. She believed that nursing required women and men of education, culture and very special preparation in order to have a correct philosophy of life, thus understanding the nature of the human person in many different cultural and environment situations. The aim of the Faculty of Nursing was and is to provide nurses’ with the opportunity to become continuous learners in order to benefit society. Prior to entry to Faculty programmes candidates must be registered with the Nursing and Midwifery Board of Ireland or the Nursing Council for Northern Ireland [15,16].

Interdisciplinary ideals

On being appointed as Dean in 1974 Miss Crowley said that the Faculty is intended to unite the medical education and the professional development of nurses and midwives within a medical school by saying that she accepted the Deanship with a deep sense of duty and with a resolve to contribute everything she could towards an honorable place for the future of nursing in Ireland and in the history of our profession. This ideal would be achieved through increased professional knowledge and expertise [1]. The early years were not without difficulty from within the college, medical profession and the nursing profession itself, and this was acknowledged by the President of the Royal College of Surgeons in Ireland during the Presentation of Diploma Awards to nurses in July 1992 when he said:

“The Faculty has since its inception in 1974 far exceeded the modest plans of the Founders and it has continued to expand and grow and keep pace with the vast developments that are seen in the world of patient care. I know members of the Faculty can think back on the difficulties of growing up and the way it had to work to gain acceptance of its existence and status not only from doctors but from within the nursing profession itself” [17-20]. He continued:

Conclusion

Following in the footsteps of Miss Crowley, the Faculty promotes nurses of vision who will maintain the ethics of their profession in all spheres of life they enter. The Faculty has taken the lead, and continues to successfully initiate, promote and develop a national system of continuing education for the profession. Nursing research can make a major contribution in meeting professional requirements and contributing to the health and welfare needs of modern society. Miss Crowley in her address titled “Continuing Nursing Education” to the first students of the Faculty in Nov. 1974 set out her principles and vision. She said that the establishment of the Faculty of Nursing is an ideal achieved to advance nursing education by bringing together the scientific level of nursing practice into harmony with modern advances in medicine, while retaining high levels of clinical nursing standards and community care. The Faculty would assist in restructuring educational programmes in order to fulfil the nurses’ role in the community and meet the needs of modern society. The nurse educator must appreciate the moral allegation to teach subjects conducive to professional development, in order to develop socially, culturally and morally. Team working requires professional preparation for taking full responsibility for bedside care or in a public health situation. Clarification of the concept of continuing education needs understanding of the operation of theory and practice. The challenge of continuing education is to make it an integral part of daily lives through acceptable organisational structures and suitable educational facilities.

1. Crowley MF (1978) Continuing Education Programmes: New Medical Ethics Programme in RCSI Notes, Faculty of Nursing, November: Royal College of Surgeons in Ireland.
2. McAuliffe Curtin D (1990) History of Certificate in Ophthalmology Nursing (1948-1990) in Eye & Ear Hospital, Dublin Address to Faculty of Nursing, Royal College of Surgeons Dublin.
3. Sister Immaculata Nichols (1990) Foundation member of the Medical Missionary of Mary (1990) Tribute to Mary Frances Crowley Medical Missionaries Midwifery Training School, Drogheda, Co Louth: April.
4. Crowley MF (1984) A Century of Service: History of Nursing Evolution from the Brehon Laws to the 20th century Commemorating the Bi-centenary of the Royal College of Surgeons in Ireland Faculty of Nursing Archives, Royal College of Surgeons, Dublin.
5. Bartley J (1990) Matron-in-charge, Irish Red Cross Hospital, Saint-Lo, France: December 1945. Deans Report, Faculty of Nursing and Midwifery, Archives, RCSI.
6. O’Brien E (1990) Samuel Beckett at Saint-Lo, The Journal of the Irish Colleges of Physicians and Surgeons, 19: 137-145.
7. Knefsey DV (1990) Honouring Mary Frances Crowley’s work in Saint-Lo Red Cross Hospital, France. President’s Address to Faculty of Nursing Foundation Members and Fellows, Annual Scientific Meeting. 19th April, Royal College of Surgeons in Ireland 4.
8. Liebard H ( 1971) Le Maire de La Ville, Ville Dr Saint-Lo, Chevalier de la Legion d’Honneur Letter sent by Henri Liebard to M. F. Crowley 20th February 1971, on awarding Miss Crowley with the Medal of Honour in commemoration of her work in Saint-Lo Red Cross Hospital, France.
9. Casey J (1976).Centre of Excellence in Nursing Education in St Seanan’s Hospital, Wexford Faculty of Nursing Archives, Royal College of Surgeons in Ireland.
10. Crowley MF (1984) A Century of Service: History of Nursing Evolution from the Brehon Laws to the 20th century Commemorating the Bi-centenary of the Royal College of Surgeons in Ireland Faculty of Nursing Archives, Royal College of Surgeons, Dublin.
11. Nursing and Midwifery Board of Ireland (2015) Code of Professional Ethics. Nursing and Midwifery Board of Ireland, Dublin.
12. Crowley MF (1979) The Christian Nurse. Faculty of Nursing Archives, Royal College of Surgeons: Dublin.
13. Kneafecy DV (1992) Opening Address, 11th Annual Nursing and Research Conference, by Past President of RCSI and Council member, Beaumont Hospital, Dublin. Archives, Faculty of Nursing Royal College of Surgeons in Ireland, Dublin.
14. Casey J (1990) Curriculum Document (1990) Faculty of Nursing, Royal College of Surgeons in Ireland.
15. Crowley MF (1987) Faculty of Nursing Curriculum Documents: Diploma courses in medical and nursing science subjects and Primary and Final Fellowship 0ctober Faculty of Nursing Royal College of Surgeons in Ireland.
16. Faculty of Nursing Annual Reports (1974-90) Faculty of Nursing Archives, Royal College of Surgeons in Ireland, Dublin.
17. O’ Flynn JD (1992) President’s Address during Presentation of Diploma Awards to Nurses July. Royal College of Surgeons in Ireland.
18. Crowley MF (1978) Address to the President and Council of RCSI: Funding of Faculty of Nursing. Royal College of Surgeons in Ireland.
19. Curtis J (1980) President of RCSI Address to the Annual Meeting of Foundation Members and members of the Board of the Faculty of Nursing of Faculty of Nursing Tribute to Miss Crowley June 13th Archives, Royal College of Surgeons in Ireland, Dublin.
20. Hederman WP (1991) Presidential Address to Faculty of Nursing Foundation Members and Fellows Annual Scientific Meeting in RCSI November Archives, Faculty of Nursing, Royal College of Surgeons in Ireland, Dublin.

© 2017 Carney M, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.