Introduction

From everyday female environments, where the domestic tasks prevail, caring for the sick and the helpless has been conducted, in which women intuitively used elements, like water, vapor, fire, animal skins, and medicinal plants to satisfactorily perform their work.^1,2 However, history has granted men leading roles concerning health care and, therefore, made it easier for their work to be paid and hold social recognition.² It is known that the first Nursing school began in India 250 years B.C., and only men were sufficiently pure to become nurses. In Athens, around 300 B.C, law banned women from engaging in work related to medicine and obstetrics; therefore, such work belonged to the male gender based on the religious and military spheres.³ Nevertheless, despite the prohibitions of the times, it has been documented that women dedicated themselves to caring for the sick who had no financial resources, thus, their remuneration was given with food or lodging.¹

During the Roman Empire, "the Parabalani" were consolidated; these were men belonging to the Christian communities who founded hospitals and cared for the sick.³ In Christianism, women assume the role in caring for the ill, bringing the exercise of charity to the neediest. For this reason, these communities were pioneers of "nosocomiums", or places where care was offered without distinction of creed, nation or socioeconomic condition. Due to the foregoing, during the Middle Ages, the role of women in care and attention to the sick and disabled was recognized.⁴

In 1952, Peplau established the first conceptual nursing model denominated “Interpersonal Relations in Nursing”, which describes the nurse-patient relationship as a means to promote therapeutic interpersonal development, with the behavior and emotions of the professional being relevant to care for the patient until the resolution of the disease is achieved.⁵ It designates that, to care, vocation, service and charity are required. Colliére⁶ describes four stages of care, starting from domestic, vocational, technical, and professional care; each giving way to the next as a result of the needs, challenges, and evolutions (intellectual, scientific, and social) of each time.

Within this context, by the mid-17^th century in Dourdan France, Marie Poussepin was born, founder of the Congregation "Dominican Sisters of Charity of the Presentation of the Blessed Virgin".⁷ During her childhood, Poussepin glimpsed the Christian foundations of her project, thanks to her rapprochement with the Daughters of Charity and Ladies of Charity of Saint Vincent de Paul, so from her position as Treasurer and Superior of the Confraternity she decided to dedicate herself completely to charity.⁸ Later, she founded a community based on Christian principles and regulations, where girls were educated and taught to work according to their age; a circumstance that raised awareness of the importance of work. These beneficiaries became the first teachers, nurses and Sisters of the Congregation. With respect to caring for the sick, Poussepin mainly offered her care to the poor. In Sainville, prior to 1698, there were no hospitals, so nuns went to rural areas that needed care interventions or medications. She also created a pharmacy, which provided home remedies based on medicinal herbs, performed cures, and designated nursing care according to the prevailing need.⁸

With Louis XIV’s mandate, hospital conformation was regulated; therein, Poussepin instructed the women who were part of the religious community in the exercise of charity and care of the sick, describing that disease should be treated according to each person’s social and cultural patterns, values, and beliefs. Additionally, she urged the application of knowledge, skills, and attitudes to dedicate oneself with passion, justice, quality, and intelligence in care.⁹ According with the aforementioned, it is valid to relate the domestic and vocational care of nursing with the work by Poussepin, given that for over 300 years it has been impacting the lives of thousands of women with a vocational, selfless, and charitable sense for humanity. Her global influence has promoted the conformation of organizations extended in four continents, which have helped the lives of children, youth, adults, and the elderly who live in precarious and disabled environments. Given this, the present study sought to describe the influence by Marie Poussepin on Nursing, taking as a starting point the perspective of life stories of the Dominican Sisters of Charity of the Presentation of the Blessed Virgin.

Methods

Type of study and sample. Historical-hermeneutical study, conducted in 2022 in Colombia. Oral histories were used as a research strategy to gather information from the Dominican Sisters of Charity of the Presentation of the Blessed Virgin to reconstruct their experiences, anecdotes, customs, and understand the influence by Poussepin on current nursing. To choose the participants, a convenience sampling was used to select the informant nuns and their different roles within the community, following the criterion of intersubjectivity to guarantee the representativeness of the testimonies. As inclusion criteria for the participants, it was established that they should have five or more years as members of the community and function as nurses or educators in the different trajectories during the course of their lives. In all, 15 nuns participated, there were no refusals or withdrawal from the study.

Ethical aspects. In compliance with the ethical requirements, endorsement from the Research Ethics Committee at Universidad Católica de Manizales was obtained, through Agreement 179. The participants were contacted in clinics in Manizales and Bogotá, Colombia, in social works and in a kindergarten in the city of Manizales. All participants signed the informed consent after being explained the purpose of the study and manner of execution and participation. They were told that there were no good or bad answers, and that all information collected would be confidential - hence, each interview was identified with an alphanumeric code and data alluding to the place, the institution and the informants were omitted - participation was voluntary. It must be clarified that neither researchers nor participants had any type of relationship before the execution of this meeting; therefore, there was no conflict of interest.

Data collection technique. To obtain the reports, semi-structured interview was used after an appointment was set up via telephone call. The interviewers were two research-teaching nurses with PhD degrees in Health Sciences and Pedagogy; the third held an MSC degree in Education. The three are recognized as researchers by COLCIENCIAS and, besides being the principal researchers, they also designed and executed the study protocol. The participating nuns were approached individually with nine descriptive-type questions during a single occasion, no type of recording was made at the request of the participants; the interviewing researcher took notes of what the participants said during and at the end of each meeting. Efforts were made to maintain a warm and trusting atmosphere. The average duration of the interviews was approximately 30 minutes. The notes were read aloud after the interview so that the informants could make the corrections deemed pertinent.

Information analysis plan. After transcribing the interviews, the three researchers began the analysis of the stories. Information was collected and recontextualized through the open and axial coding system using ATLAS.ti9 software. During the interpretation procedure, copying, intensive reading, note taking, analysis, first epigraph of the report, coding, grouping, and determination of categories were made towards analyzing the symbolic efficacy of the stories, triangulating the information with existing evidence, so that the results were contrasted with similar or divergent positions.

Results

The work obtained 15 interviews from nuns belonging to the congregation of Dominican Sisters of Charity of the Presentation of the Blessed Virgin, ranging between 30 and 93 years of age. The participant with the most experience in congregational life had around 60 years and the one with the least experience only had 5 years. Of all the nuns, five were nurses, five were teachers, and the remaining five supported care tasks of the Congregation from their area of expertise.

During the analysis process, three categories emerged, grouped as follows: I. Responding to the call of Jesus through service to the community, 2. Under the legacy of charity, respect for life and the dignity of human beings, and III. Caring for life as a foundation of nursing. Each of these is described ahead.

Discussion

Marie Poussepin’s legacy, given through the activities carried out by the Congregation, has deepened the foundations in the academic and practical aspects of nursing, as well as in the moral, spiritual, and human foundations necessary to execute nursing care in today's society, strengthening the technical and professional era of a practice that emerged empirically. It should be noted that the congregation of the Dominican Sisters of Charity of the Presentation of the Blessed Virgin constitutes an organization that promotes the active life of its nuns, favoring their spiritual development in the light of the Gospel and opting for their academic and professional enrichment. Hence, within the organization, there are three fields of action related to health, education, social, and parish ministry that are consistent with the life course approach defined by the Ministry of Health as "an approach that addresses moments of life, recognizing that human development and health outcomes depend on the interaction of cumulative experiences and present situations of the individual influenced by the family, social, economic, environmental, and cultural contexts.¹⁰

The findings coincide with a study on anthropology and care, which explained how the development of the culture of care was not only carried out through Christianity, but through all religions that showed concern for the sick. In this aspect, it is worth mentioning that the Christian culture of care addressed the idea of hospitality.¹¹ It should be stated that, regarding the notion of hospitality established by nursing over centuries, not only the technical functions of its work were addressed, but also the skills for the exercise of charity, considering that care should be exercised by consecrated individuals.⁷ In other words, and bearing in mind the current practical and moral development of the profession, comprehensive care arises when a genuine relationship is established between the caregiver and the person being cared for. Hence, Christian charity is based on the execution of actions, passing the care of the poor and sick to an important social level, that is, what was once an occupation of slaves became a sacred vocation. Service, through caring for the neediest, went on to be seen as a duty of men and women who profess a faith.

History recounts Marie Poussepin’s childhood around the wars and plagues that left the population in precarious conditions of job insecurity, health, and economy. Poussepin, thanks to her mother and her closeness with the gospel, set out to serve the sick from a very young age, learning to visit them and provide them with food.⁸ The foregoing is similar to the foundation upon which the participants have based their work within the congregation, where the presence of these workers is representative, not only in the domestic scenario of the needy, but in those scientifically endorsed, such as they are: the hospital, the school, and the university.

Nursing participates actively in caring for patients, and when it is aimed at strengthening the family environment, it improves people's self-esteem and level of confidence, being able to potentiate their possibilities and the positive consequences.¹² This condition is consistent with the work by the participants in contexts unrelated to illness, and where it is possible to generate greater social responsibility. In this regard, a study exposes the emotional support provided by the nursing staff to hospitalized patients as relief to the soul. Reiterating that nurses require a high level of sensitivity to interpret the patient’s verbal and non-verbal manifestations associated with their perception regarding the illness, the hospitalization and treatment process, and refer that emotional support should be understood as a form of careful.¹³

Moreover, Fernandes and Siles ¹¹ consider that female social work arose as a response to social emergencies, which at the time produced the fulfillment of care for free or "volunteer work". Said antecedent impregnated it in his course, mainly under the leadership of the church, as an unpaid activity carried out by those who perceived a group of people in deprived situations, who demanded charity.¹⁴ This evidence is viable and latent in the discourse used by the participants, given that they support their function and philosophy on this vocational principle that seeks to overcome discomfort or vulnerability. For this reason, the Congregation is the non-profit group in charge, in the city of Manizales, of visiting areas and attracting individuals in vulnerable conditions (women heads of household, people with disabilities, children or the elderly in social abandonment), to refer them to institutions that have the pertinent economic and social conditions to favor their integral state of health. In its social works, it promotes continuity in health care to the community through the dispensary, which provides medications under a medical formula to people who do not have the resources to obtain them.

Likewise, it is highlighted that the labor of care in the diverse settings of missionary work is not disassociated from health regulations. On the contrary, the function of the Congregation is viable because it recognizes the family as subjects of care and health care as a permanent process, focused on disease prevention. Such an act permits providing optimal tools for each person from their community to manage their self-care,¹⁵ thereby, it is worth highlighting this organization for its contribution in promoting health and strengthening self-care in the community. That is, the missionary work, provided around care, recognizes that health problems are generated or enhanced by multiple factors that must be intervened from childhood, to promote adequate development through optimal educational conditions that offer strategies for the correct physiological, mental, emotional, and spiritual development of people. This discovery is true compared to the educational work that has historically been conducted and that has been linked to health care.

Another fact found and of interest is that the missionary work around care has sought, over the years, to recognize that health care must be comprehensive and not fragmented. Authors, like Castro et al.,¹⁶ refer to the vitality of committing and getting involved in the process and never leaving aside the humanization of the task in favor of improving health results. Thus, the data analysis of the present study is aligned with that described in the literature, given that through reports by the participants, caring becomes visible when someone's life becomes important for the other, and they decide to participate in it. It is through acts that result from understanding of the state of others and the purpose of helping them.¹⁷

Although the humanization of health services presumes being an elemental component during the individual's health restoration process, Castillejos et al.,¹⁸ express that the relationship of emotional intelligence with the care provided by nurses contributes to the emotional, spiritual, and aid components. Added to the fact that it is a determinant to improve the quality of care for people hospitalized. Then, the work by Poussepin corresponds to the emerging trends in human healthcare, despite adversities present during this commendable work and which indicate the workload, imposition of administrative activities that prioritize indicators, costs and protocols, development of individualistic thinking, inconsistency between theory and practice, and lack of recognition are barriers that have made us think that values and principles, among others,^19,20 have deteriorated care, mainly institutionalized care. Consequently, vocation, will, patience, respect for the dignity of others, charisma, warmth and compassion are requested from the environment where the study phenomenon was addressed.²¹

Nursing epistemology encompasses the comprehensive care of humans through health promotion, disease prevention, and timely diagnosis and treatment in the required dimension. In response to the aforementioned, the individual's physiological, spiritual, and emotional well-being is favored if the vulnerability of life is considered when the required care is not received.²²

This study concludes that Marie Poussepin's contribution to nursing care has been experienced since the foundation of the work. It is evident that said work is not clearly limited to the institutionalization of care; on the contrary, care is present in various contexts where nuns execute their mission. In this sense, the legacy in mention has influenced nursing from the religiosity, responsibility, and vocation of those comprising this congregation, imprinting a character of service and respect for others, in response to the love of God. Historically, it has not been limited to a degree in the area, given that, from the very formation in the community, women have been taught and based on care; it is then a professional act and responsibility towards others that deserves an exhaustive practice.

The limitation in this study lies in that not all the participants were nurses; nonetheless, under the religious legacy, the act of caring is a primordial part of their work.