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The History of Nursing Education in Modern Greece

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Balkan Military Medical Review
Jul - Sep 2013; 16(3): 375 - 381

Review Article

The History of Nursing Education in Modern Greece

Theologia ZIOGOU1, Aliki DIMITRIADOU2, Evangelos FRADELOS3*

Affiliation of authors:
1. Clinical Lecturer, Department of Nursing, Alexander Technological Educational Institute,
Thessaloniki, Greece.
2. Assistant Professor, Department of Nursing, Alexander Technological Educational
Institute, Thessaloniki, Greece
3. Nurse RN, State Mental Hospital of Attica “Daphne”, Athens, Greece

Corresponding Author:
Evangelos FRADELOS
Davaki 20, Glyfada, 16674
Athens,Greece
Tel. +3066946228458
E.mail: evagelosfradelos@hotmail.com
 376
Abstract
The following historical study presents
the chronicle of the evolution of nursing
education in modern Greece. This study
indicates that although Nursing started
as a bread-winning occupation of low
educational level, today it is taught in
higher education institutions
(Universities and Technological
Institutions). It requires specialized
knowledge and techniques within its
application, which shape the level of
quality of care in all health services of
modern Greek reality.
Keywords: History, Evolution, Nursing
education, Greece, Nursing schools
Introduction
Nursing is a science and an art. It is
about servicing the health needs of
individuals, of families and society in
general, with an ultimate goal to maintain
health, prevent disease, as well as
providing treatment that will restore
health.
The nursing profession seems to
have appeared in the history of mankind
from the time where a fee was a
prerequisite in order for a specialized
person to provide healthcare to those who
needed it[1].
Within the passage of time, the
inevitable changes that occurred in people's
lives reformed the nature of the nursing
from a family affair into a profession [2].
Leader of this effort was the great
British nurse Florence Nightingale, whose
successful actions in the Crimean War
(1854-1856) were succeeded by the
Balkan Military Medical Review
Vol. 16, No 3, Jul - Sep 2013
foundation of the first nursing school at St.
Thomas Hospital in London in 1860 [3].
Greek Nursing was also affected by
the global growth of Nursing and followed
an equal path over the years, with
significant growth in the recent years.
Briefly, this historical study
highlights and projects the important
nursing educational work that was
organized by the troubled Greek state from
the time of its foundation until today.
In order to conduct this study, the
methodology of historical research was
used. Sources of data were the Laws and
decrees of the time, publications such as
articles, studies, as well as text and
photographs regarding this matter. For
archiving the material a classification
system of data was used, according to the
source and its alphabetical and
chronological order.
The Evolution of Nursing in Modern
Greece
After the fall of Constantinople, the
Byzantine capital city in 1453, organized
nursing stops its development and is left to
the private initiative. During the siege of
Thessaloniki by the Turks women were
offering nursing services. Later,
throughout the period of Ottoman rule, the
monasteries were the centers of social
welfare and nursing care [4].
After liberation and creation of the
new Greek state, the health status of the
country was in bad shape and the
healthcare problem was huge. There were
too many disabled, injured and sick.
Greece, however, had well-trained doctors
at that time. In the Ionian Islands, as early
as the 17th century, Medicine was taught
in the so-called „Exisfalismenon‟ Acade
my, the Academy of Fertile and the
Academy of the Wanderers [5].
 Ziogou Th. et al: The History of Nursing Education in Modern Greece
In 1835 the Medical Society of
Athens was founded and in 1837 the
School of medicine of the University of
Athens [6, 7]. The first Hospital of Athens
was the Military Hospital „Makriyannis‟
(1836) and the state Hospital „Elpis‟
(1836) [8, 9].
The successful implementation of
medical services to hospitalized militaries
and other citizens was provided, in support
of the medical work, by the well trained
and responsible nursing personnel.
Stages of Evolution of Nursing
Education in Greece
Hospitalization of patients in the
first hospitals after the liberation of the
country was exercised by practical nurses.
They were women with low educational
levels who practiced the nursing
occupation to earn their living [2, 4]. The
first effort for educated and trained nurses
that were in fact men, was made by the
Directorate of Health Services of the Greek
Army, which created the first „School of
Nursing‟ by a decree "About the
recommendation of school for Nurses" on
August 18, 1861 [10]. The establishment
of the School occured about the same time
with the School of Nursing of Florence
Nightigale at Saint Thomas Hospital in
London (1860) [11, 12].
It is also mentioned in the great
Military and Naval Encyclopedia: "The
school was founded on the 18th of August
of 1861, aiming to educate experienced
nurses for peace and campaign Services.
The soldiers that had successfully attended
the school were given the specialty of
nurse and were used as such; this specialty
was also noted on their army certificate"
[13].
The choice of soldiers - nurses
from „the excellent or unimpaired of trim‟
and the notice that they should know
reading and writing indicates the interest of
the army department to be staffed by a
377
body of nurses selected from the finest of
the enlistment. Approximately 160 years
ago, the very few soldiers who knew
reading and writing, were considered well
educated [11, 14].
Finally, it should be noted that
during the „Greek-Turkish war‟ in 1897 the
nurses - soldiers fulfilled their debt to both
Asclepius and Ares (Mars): “…officer and
soldier that showed admittedly his
superhuman bravery ... and those of the
Healthcare sector, doctors and nurses that
took part and two of them were killed!”.
[14] Those were Verginis Athanasios from
Kalamitsi of Corfu and Dimitrios Tsamis
from Mandra of Attica [15].
The first efforts for professional
education for nurses belong to Queen Olga,
who in 1875 founded the first School of
Nurses called „Evangelismos‟: it was the
third in the world [16]. Nine years later, in
1884, the hospital „Evangelismos‟ was
founded, one of whose purposes was "... to
educate women nurses according to the
rules of science". Initially, the attendance
at this nursing school was for 2 years.
Later, in 1930 it was reorganized and
became a three-year program. The
educational program of the School had a
significant positive impact on the nursing
services of the hospital and in the patient
treatment provided. Training courses were
organized, as well as seminars and special
symposiums. Graduates of the school were
also retrained abroad [17]. They were
extremely hard-working with and did so
with a lot of heroism during the Balkan
wars (1912-1913), the flu epidemic
(1918) the dengue fever epidemic (1928)
and during the war of 1940-'41 [1, 4].
The establishment of the
Evangelismos Hospital must be considered
as a turning point for two reasons: first, the
relatively comfortable surroundings began
to attract people and not frighten them, and
secondly it started the systematic
scientific training of women nurses. As it
was characteristically described in an
 378
article written by Trifon Andrianakos in
1930 in the journal Greek Medicine “Until
the time of the creation of 'Evangelismos‟
in Greece, and most especially in Athens,
the idea of hospitalization was frightening
for the poor and the general population…
as for the wealthy and educated people,
they preferred home healthcare and
considered hospitalization of their
relatives as inappropriate” [18, 19].
As time passed and after the Balkan
wars had ended, in 1914, the Hellenic Red
Cross (HRC) founded a two-year
attendance school for the Sisters
assistants of HRC. Zenovia Bolla, a Greek
graduate Sister from the School of Nursing
of London Hospital, was asked to be the
director of school. Marianthi Lekatsa,
which had been trained in the school of
Boston, also taught there [2, 3]. The
Graduates of the school, given an existing
law that that was published in the Official
Gazette in May 1914, were granted by the
Greek Government the first official license
to practice the nursing profession [1,3,20].
Furthermore, in 1924 the HRC
founded the „Higher School of Nursing of
the Hellenic Red Cross‟, the first in Greece
with a three-year training program since its
foundation. Until then, the students of
HRC were trained in the hospital
„Evangelismos‟ [21]. In 1937, with the
Law 613/1937, the school of visiting
sisters and nurses was founded inside the
Health School of Athens in Ambelokipoi,
and was supervised by Helen
Vassilopoulou [22].
In the war of 1940, Sisters worked
exceptionally well under difficult and
dangerous conditions. The Hellenic Red
Cross mobilized approximately 3,000
Sisters, of which 300 were graduates and
2,700 volunteers. All these Sisters covered
the nursing needs of the Armed Forces of
the country. Mountain surgeries,
ambulance stations, military and Floating
Hospitals. Many of these Sisters were
injured and some were disabled while 14
Balkan Military Medical Review
Vol. 16, No 3, Jul - Sep 2013
of them gave their lives for their country
[1, 12]. The State acknowledged the
sacrifices of Sisters nurses and in 1946 the
Greek Parliament unanimously passed the
Legislative Decree (LD) 663/46 by which
many matters relating to the Sisters nurses
were settled [23].
The year 1946 was a milestone in
the evolution of nursing in our Country. By
LD 663/1946 the title „graduate nurse‟ was
established and the procedure for
dispensing license to practice was defined;
the same law described the duties,
organized nursing education and
addressed the careers of the Sisters, the
certificate of the old-type of high school
was considered an essential qualification
for the introduction of female students at
the schools of nurses. Greece was the first
Country in Europe that established the
School Certificate as an entry qualification
to nursing schools, followed by Belgium
ten years later in1956 [4, 24, 25].
In May of 1948 the Board of
Nursing was established at the Ministry of
Health, which was responsible for Nursing
Education, keeping records of the nurses
and for all matters that were related to the
practice of the profession [4, 26, 27].
Later on, new Schools for Nurses
were created and the first was in 1946, the
Military Officers Schools for Nurses in
Athens. The Director of this school was
Cleopatra Avagianou, a graduate of HRC
school [28]. In 1954 another State Nurses
School was created in Thessaloniki [29].
That was followed by the
establishment and operation of several
training schools for Nurses with a three- or
four-year study, under the auspices of the
Ministry of Health and Welfare [4, 27].
In chronological order according to
the year of their foundation these schools
were:
Nursing school of Agia Sophia Hospital,
founding year 1960;
Nursing and Health Visitors School of
PIKPA, founding year 196;
 Ziogou Th. et al: The History of Nursing Education in Modern Greece
Nursing school of Aglaia Kyriakou
Hospital, founding year 1964;
Nursing school of Pammakaristos Hospital,
founding year 1965;
Nursing school of 'King Paul' Athens
General Hospital, founding year 1969;
School of deaconesses and nurses
„Olympiada', founding year 1969.
In 1973 five nursing schools were
founded at the Centers for Higher
Technical Training (Ministry of Education)
in Athens, Thessaloniki, Patras, Larissa
and Iraklion [1, 2].
In 1979 by Presidential Decree (PD
184/79) that was published in the
"Government Gazette" (GG 5IA/15-3-
1979) the Department of Nursing was
founded at the School of Health Sciences
of the University of Athens [30, 31].
Since 1983, the department
operates autonomously. The first Ph.D.
Nursing Diploma from a Greek University
was awarded in June 1987 to a graduate of
the Nursing Department; since 1993 it
started more systematically as a two-year
Postgraduate study Program before the
Ph.D. [1,2]. Furthermore, by the Law
3391/2005/ “GG” 240/4-10-2005 the
Department of Nursing at the University of
Peloponnese was founded and began its
operation in the academic year 2005-2006
[32].
The Law 1404/1983 established the
Technological Educational Institute (TEI)
under the auspices of the Ministry of
Education as the Centers for Higher
Technical Training and the nursing
schools of various hospitals were abolished
[33]. Thus, Departments of higher nursing
Schools, health Visitors and Nursing, that
were under the jurisdiction of the Ministry
of Health, Welfare and Social Security and
Centers for Higher Technical Training
were joined to the technological education
[1, 3].
The Law 2916/2001 joined all the
TEIs in higher education [34]. Today there
are only two departments of Nursing at
379
Universities, one in the University of
Athens and the second at the University
of the Peloponnese; there also exist seven
nursing departments in Technological
Education institutions [1, 3]. Thereby the
whole "nursing education" has been
transferred from the Ministry of Health
(Boarding Schools by bedside of the
patient, according to Florence Nightingale)
to the Ministry of Education (according to
the American education system) [1,3,29].
Nursing education was extended to
issues of social sciences, management
practices and teaching, Legislation, Public
Health, Pediatrics and Psychiatry. By the
Law 1579/1985 four nursing specialties
were established: Internal Medicine,
Surgery, Mental Health and Pediatric
Nursing. By the same law the term that
was used sister-nurse was replaced by Title
Nurse - RN [35]. These programs are
operating satisfactorily until now.
Responsible for implementing them are
nurses along with the managers of nursing
Services. By addressing all the problems
that had arisen, they managed to preserve
the gravity and validity of their programs,
so for ten years now are steadily sought
after by nurses from all over Greece [27].
So Greece became the first
European country to apply generalized
nursing programmes, as America and
Canada did many years ago. It should also
be noted that the education that was
provided at the time, was one of the finest
in Europe. It was shown after Greece's
accession to the European Union (EU) in
1981, that the nursing programmes were
fulfilling the EU guidelines dating from
1977 [1, 36].
It should also be noted that after
1990 the Vocational Training Institutes
(IEK) were created, which provided
specializations in nursing. According to the
Presidential Decree no. 210/2001 license to
practice the profession is granted to those
that have a diploma from the Organisation
for Vocational Education and Training to
 380
the level of post-secondary vocational
training, to specialties such as „Nursing
Traumatology‟, „Nursing for Oncology
Diseases‟, „Operating Room nursing‟,
„Nursing Persons with Mental Conditions‟,
„Intensive Care Unit nursing‟ by IEK and
identifies specific nursing actions that have
the ability to perform [37]. To those that
hold a diploma by IEK and after a three-
month internship, a licence to practice the
profession as Nurse Assistant is provided
by the departments of the Ministry of
Health and Welfare (Official Gazette
165/2001) [38].
Conclusions
The objective study and research of
the progress that Nursing and Nursing
Education forged through time, outlines its
contribution to society as well the position
that is acknowledged by society today.
Therefore the development of Nursing in
modern Greece followed the general
economic and health growth. Influenced by
the tradition of Hippocratic medicine,
modern nursing seeks to secure, protect
and maintain healthcare of all people,
which is a major factor in the multilateral
development of the society and the
creation of higher culture [39, 40]. It
synthesizes scientific knowledge,
techniques and humanitarian behaviour
and its special responsibility is to ensure
holistic and individualized nursing care to
the individual, the family and the
community [41]. Moreover, the modern
nursing is a synthesis of the elements of
science, art and intellectual treatment of
people , based on the view of people as a
bio-psycho-social and spiritual being, that
believes in the inner worth and value of
health and life, as well as the love and
humanity that should be provided when
attending to a patient. It should be
concluded that not only knowledge and
skills but also civilized and virtuous
personality of nurses are crucial to the
Balkan Military Medical Review
Vol. 16, No 3, Jul - Sep 2013
development and social recognition of
nursing [42].
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