Cancer nursing: weaving the tapestry for our second century.

It is an honour and a privilege to have been invited to give the closing address for your twelfth annual national conference on “Weaving the new tapestry for oncology nurses: Our future is now.” I am sure each of us has a mental picture of a tapestry. I think of the many beautiful tapestries, truly works of art, in museums around the world, tapestries of heavy cloth woven with rich, varicolored designs, scenes from history, stories from our past. Some hang in tatters, scarred by the passing of time, but even so they maintain their beauty, symbols of glorious days gone by. The dictionary speaks of tapestry as “heavy,” and “handwoven,” and “complex.” The making of a tapestry has been called a “collective art” because it combines the talents of the designer, the painter, and the weaver. When one logs on to the Internet, tapestry relates to land, time, music, food. What we have been relating to in the past few days is the “tapestry of cancer nursing.” Nursing, like a tapestry, is a collective work of art that requires the input of many. The warps of cancer nursing stretch throughout our history like the threads of the fabric web that support a tapestry caring, commitment, cooperation, a dedication to learning, to discovering what is new. On this foundation, each of us weaves our own individual weft, our own individual contribution which, collectively, paint the full picture of our time. Alone, we are a tiny thread. No weft thread carries the full widths of the tapestry. Collectively, however, we are the tapestry. Here today, we are creating new masterpieces for the future. Consider the cancer nurses’ tapestry of the past century. Were those nurses not weaving the threads for our own future? Over 100 years ago, Florence Nightingale said, “Unless we nurses are making progress every year, every month, every week, nursing will go backwards. No system shall endure which does not march” (Nightingale, 1969). The tapestry begins. The “nurse in white” emerged in the early 1900s when nurses were trying to dissociate themselves from the profession’s previous drunken and unkempt image. Until then, nurses had worn dark colours characteristic of military and religious roots. Nurses began establishing their professional organizations. At the turn of the century, cancer was an incurable disease. The death rate was 90% and many people thought it was contagious. Sources of information about nurses in cancer care were minimal in those early years. The Nursing Studies Index lists only 16 articles related to cancer between 1900 and 1930 (Henderson, 1972). Nurses wrote three of these articles. These nurses added their stitches to the tapestry of nursing. Rice (1902) stated, “While cancer has not yet been classed with the transmissible diseases, there are authentic cases where a wife has been infected with cancer by her husband and vice versa” (p.89). This belief was so common that some nurses refused to care for patients with the disease. In 1906, Charles Plumley Childe, a British physician, wrote the first book to inform the public about cancer: The control of a scourge (Ross, 1987). It is of interest that the word cancer was not used even at a time when hospitals for cancer patients existed and the organizational fight against cancer was beginning. Cancer nursing in the early 1900s was primarily concerned with bedside care and comfort measures for surgical patients (Yarbro, 1996, 1998). The majority of cancer patients presented with advanced cancer and nurses had to develop creative ways to handle the numerous difficulties encountered. In 1915, Tucker discussed caring for a patient with bladder and rectal fistulas as a result of pelvic cancer (Tucker, 1915). Pads were not thick enough to prevent the bed sheets from getting wet. She improvised by using an air cushion with newspapers underneath and muslin wrapped around the cushion and newspapers. When soiled, only the muslin needed cleaning, which meant a great saving on laundry expenses. As a home nurse, she was provided a budget to carry out her work but was expected to save as much as possible. In those early days, there were considerable delays in detection and treatment of cancer. Examples of medical misinformation sound shocking today: a woman with breast cancer was told by her physician to “wait until it begins to bleed and then come back, and I will tell you what to do.” Bleeding of a cancerous uterus was ascribed to “a return of menstruation,” “rheumatism,” or “a cold in the pelvis.” Other common sayings were, “It is your menopause,” “Don’t bother it till it bothers you,” and “Go home and forget about it” (American Cancer Society, 1924-1925). During the 1930s and 1940s, documentation of cancer nursing practice and care was still minimal. Cowan (1934) noted that cancer nurses need to pay attention to pain control and the mental needs of patients. Colonic irrigations of a salt solution were used to treat patients with colon cancer. The role of the radiation therapy nurse was described by Hopp (1941) who noted that no special routine was followed in caring for patients with cancer and efforts to alleviate side effects of nausea and vomiting had not been successful. Lemon juice, sour wine sipped slowly, and ginger ale were used for nausea, vomiting, and anorexia. The first half of the 20th century is noted for the use of ionizing radiation in the diagnosis and treatment of cancer and the extension of surgical procedures. Progress was made by surgeons and radiotherapists, but it was the nurse who provided the care and comfort (Yarbro, 1998). Think about the conditions under which those nurses worked. Think about the advantages we have today. The second half of the century is noted for significant progress in systemic chemotherapy, further progress in radiation therapy, multimodality therapy, and an increased understanding of cell biology. Cancer nurses at major institutions of cancer care developed innovative programs to provide care to cancer patients. Exercise classes to piano music were held for patients with breast cancer who had radical mastectomies, the procedure of colostomy irrigation was developed, and tube feeding was considered technology at its best! (Yarbro, 1996). By the late 1950s, the nursing profession began to be concerned with educational preparation and about who we were and what we