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Nursing Champions - The NT Diamond 20

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Back in September we asked you, our readers, to nominate the most influential nurses of the past 60 years and, on Thursday 4 December, Nursing Times unveiled the Diamond 20.

We took your most popular choices and asked our panel of judges - themselves some of today's leading nurses - to use this as the basis for the final list, which appears here.

'The NT Diamond 20 is quite simply to acknowledge the contribution that individual nurses and nursing care bring to health care,' says Nursing Times editor Alastair McLellan.

It is not often that individual nurses get lauded, he adds. 'Nurses are teamworkers. As a result, some of the really significant contributions made by individuals tend to get lost.'

The NT Diamond 20 are the thinkers, writers and doers who have made a difference and changed the face of the profession from 1948 to 2008.

Click here for a PDF of this article with pictures

1. NancyRoper, 1918-2004
Developed the activities of daily living theory which has influenced generations of nurses

Nancy Roper's theory of nursing has influenced every generation of nurses since its publication in 1976, not just here in the UK but in Europe and the US too. There is not a student nurse in Britain who does not use it.

Her model set out the common core of the nursing required by each patient, regardless of diagnosis or setting, based on everyday living activities. She reminded nurses to look at the whole patient and taught them to look beyond the obvious, such as eating and drinking, to aspects such as sexuality, and death and dying.

Ms Roper had always wanted to nurse and left school in Wetheral, near Carlisle, to train first as a children's nurse and then as a general nurse. In 1943, just as she registered, the Territorial Army called up several tutors and she was asked to become a teacher. Only later did she gain her clinical experience before moving into writing and research.

Ms Roper received neither a state honour nor an RCN fellowship.

2. Dame Cicely Saunders, 1918-2005
Founder of the modern hospice movement

Dame Cicely Saunders devoted her life to making sure people could die with dignity and free from pain. Convinced the last days of a person's life could be made happy, she said: 'You matter because you are you, and you matter to the last moment of your life.'

She came from a wealthy but unhappy home and, against her will, was educated at Roedean, the exclusive girls' school. The shy and gawky child left school with, as she put it, a 'compassion for the underdog'. She went to Oxford, but left to become a nurse. When a back injury forced her out of the profession, she retrained as a medical social worker and later as a doctor, largely to study pain relief. In 1948 she fell in love with a patient, David Tesma, who was dying of cancer. He left her£500 to start a hospice - a home or hospital to relieve the physical and emotional suffering of the dying.

Almost 20 years later she opened St Christopher's Hospice in south-east London, where she died in 2005.

3. Virginia Henderson, 1897-1996
Developed a definition of nursing

Born in Kansas City, Missouri, Virginia Avenel Henderson graduated from the Army School of Nursing in Washington DC in 1921 and gained her master's degree at New York's Columbia University. Her major contribution was to define nursing as 'assisting individuals to gain independence in relation to the performance of activities contributing to health or its recovery'.

She was said to have delineated nursing from medicine although her own view, that nursing and medicine belonged on a continuum, was rather different.

She was radical, witty and compassionate. In 1988, in an interview with Trevor Clay, then general secretary of the RCN, she defended basic nursing care (then out of vogue) as the 'basis for physical comfort' and sympathised with graduate nurses who were too busy with complex tasks to nurse patients.

Hospital care should be for service, not profit, she said, before proclaiming Cuban nursing to be among the best in the world.

4. Patricia Benner
American nurse theorist and author of FROM Novice to Expert

Where Ms Henderson and Ms Roper were concerned with the 'how' of nursing, Patricia Benner examined how nurses learn to nurse. Her 1984 book From Novice to Expert is still in print and much read.

The importance of this work is hard to overestimate. Her theory is that the knowledge embodied in the practical world is important for the development of nurses' skills and ability to care. By articulating the different stages of clinical development in nursing practice, she placed a new value on clinical experience.

She also helped educators and preceptors understand what they could realistically expect of new graduates - and how to help them develop into skilled nurses.

She has influenced nursing practice and education in her native US and internationally..

Still researching, writing and lecturing on ethics and nursing education, she is professor emerita at the University of California, San Francisco and a fellow of the RCN.

5. Nola Ishmael
First black director of nursingin London and mentor

Born in Barbados, Nola Ishmael was tempted to England to nurse by letters from a friend telling how much fun she was having as a trainee nurse in Lancashire.

She went on to become the first black director of nursing in London, before moving to the Department of Health in 1995, where she became professional private secretary to the chief nursing officer. Focusing on minority ethnic groups, she championed staff development and advised on health issues. She played a pioneering role in the Mary Seacole awards.

In a 2007 speech marking the launch of Many Rivers to Cross, a book about the Caribbean contribution to the NHS, she said: 'When word of my promotion to director of nursing got out, I got calls from far and near saying how proud they were of me and, when I went to the Department of Health, everyone I met had the widest smile and words of congratulations.'

She was awarded an OBE in 2000 and retired from the DH in 2003 but is still busy with charity work and mentoring young nurses from minority ethnic groups.

6. Jane Salvage
Empowered nurses in former Eastern Bloc

A nurse, activist, writer, campaigner and academic, Jane Salvage encouraged nurses to think for themselves. One of her achievements was as European nursing officer at the World Health Organization in the 1990s.

The iron curtain had come down and she saw that the need was not for a Europe-wide curriculum but to develop nursing in Eastern Europe and the former Soviet Union.

She created networks and nursing programmes, the legacies of which are still being felt today. She is visiting professor at the Florence Nightingale School of Nursing and Midwifery at King's College London.

7. Christine Hancock
Former RCN secretary and dignity campaigner

Nurse and midwife Christine Hancock made a big impact as RCN general secretary from 1998 to 2001, shifting the public view of the RCN back to one of leading a caring profession after years of pay disputes.

A colleague recalls: 'When I first met Christine, she was about to go to the RCN from a trust where she ran a long-stay hospital which had a horrible shared clothing policy. She ran a 'knickers for all' campaign and told the staff she wasn't going to the RCN until everyone was wearing their own underwear.'

She is now European director of the Oxford Health Alliance.

8. Baroness Audrey Emerton
Chaired the UKCC and was Chief Commander of St John Ambulance

Audrey Emerton's career began in 1953 and she is still going strong as a cross-bencher in the House of Lords. Her peerage was given in 1997 for her services to nursing and St John Ambulance, where she was chancellor and chief commander.

She was responsible for the 1988 closure of the Darenth Park Hospital in Kent, an asylum for people with learning difficulties, and chaired the UKCC. Keeping small talk to a minimum, she prefers to speak up when it really matters.

9. Dame Christine Beasley

Chief Nursing Officer for England and the 'matron' in whitehall

By her own admission, it is over 20 years since Dame Christine Beasley, England's chief nurse, handled a bedpan. Yet she is perceived as the nurses' nurse, the matron in Whitehall.

She arrived at the Department of Health in 2004, at the height of the furore about healthcare-associated infections. She seized the opportunity and made it a nursing responsibility. She is known to be politically astute - and utterly serious.

10. Judy Waterlow
Pressure ulcer care reformer

Judy Waterlow was a clinical nurse tutor when she designed her pressure ulcer risk assessment tool in 1985 to help her students. Now the most-used scoring system of its type in the UK, it has helped nurses prevent countless pressure ulcers, saving untold pain and money. It has been adapted for use in the community as well as acute settings. Ms Waterlow, who still works with the Tissue Viability Society, received an MBE this year.

11. Trevor Clay, 1936-1987
Won fair pay for nurses

Trevor Clay was the man who got nurses a fair pay deal as general secretary of the RCN from 1982 to 1987. He introduced the RCN to cross-party campaigning and developed a high media profile in the campaign that won an independent pay review body, clinical grading and a wholesale review of nursing education. He died from emphysema, aged 50.

12. Professor Dame Jill Macleod-Clark
Was integral to taking nurse education into universities

Dame Jill was professor of nursing at King's College London in the 1990s and played a key role in raising awareness of the importance of communication skills and health promotion in nursing. She influenced the move of nursing education to universities, championing evidence-based practice. Now at Southampton University, she is an advocate for robust education pathways and advanced nursing roles.

13. Hildegard Peplau, 1909-1999
Developed the concept of psychodynamic nursing

American nurse theorist Hildegard Peplau coined the term psychodynamic nursing, describing how the nurse-patient relationship changes over time. Her seminal 1952 work, Interpersonal Relations in Nursing, was republished in the UK in the 1980s becoming a bestseller when Ms Peplau was in her 90s.

14. Christine Moffatt
Revolutionised the care and management of leg ulcers

Professor Christine Moffatt, CBE, has transformed leg-ulcer management and the lives of countless patients through 20 years of nursing research, practice and education, making specialist wound care in the UK the best in the world.

She is a nurse consultant at St George's Hospital in south London and president of the Leg Ulcer Forum.

15. Ann Keen
Junior health minister

District nurse, one-time general secretary of the Community and District Nursing Association, an MP since 1997 and now a junior health minister, Ann Keen is thought to have significant influence in the government to take forward nursing and the profession's concerns.

16. Graham Pink
Nursing's best-known whistle-blower

Appalled about understaffing in the geriatric ward at Stepping Hill Hospital in Stockport, staff nurse Graham Pink wrote to everyone he could think of, finally going public on the front page of Guardian Society in 1990. He was sacked for his actions.

Now 80, he still supports whistle-blowers.

17. Phil Barker
Developed the tidal modelof mental health nursing

Mental health nurse and psychotherapist Phil Barker developed the Tidal Model, which encourages nurses to explore people's stories as a way of helping to reclaim mental health. It is now used internationally.

Mr Barker was the first professor of psychiatric nursing practice at Newcastle University. He retired in 2008 to focus on lecturing and painting.

He was famous among his colleagues for his red clogs, long beard and being great company.

18. Janet Marsden
Advanced care in Ophthalmic and emergency nursing

A passionate ophthalmic nurse, Janet developed advanced practice roles in the specialty. She has written extensively about ophthalmic and emergency care and taught the subject all over the world.

She is also an editor of Emergency Triage, developed in Manchester, which is now used extensively in the UK and internationally.

19. Barbara Stilwell
Pioneer of the nurse practitioner role in the uk

Barbara Stilwell pioneered the nurse practitioner role in the UK, taking the idea forward as a role model, researcher, writer and - as programme director of the RCN - government-level adviser.

20. Claire Rayner
Advocate of patient rights

Claire Rayner, OBE, is a nurse turned journalist and patient advocate who has championed patient rights, breast cancer and hearing loss. Always positive about her nursing background and how it informs her wider work, she is also president of the Patients Association.

Nursing Times compiled the NT Diamond 20 in association with Barts and The London NHS Trust, Chelsea and Westminster Hospital NHS Foundation Trust, NHS Professionals and the RCN.

The judges were:

  • Trish Morris-Thompson, chief nurse, NHS London;

  • Janice Sigsworth, director of nursing, Imperial College Healthcare Trust;

  • Tamar Thompson, adviser external affairs/chief nurse, NHS Institute for Innovation and Improvement;

  • Gail Adams, head of nursing, Unison;

  • Peter Carter, general secretary, RCN;

  • Anne O'Brien, director of clinical governance, NHS Professionals;

  • Andrew MacCallum, director of nursing and patient services, Chelsea and Westminster NHS Foundation Trust;

  • Kay Riley, director of nursing and matron, Barts and The London NHS Trust;

  • Alastair McLellan, editor, Nursing Times.

Do you agree with the judges or should other influential nurses be included? Join the debate in our forums.

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