Andrés Fernández
An author of the ‘Instrucción de Enfermeros’ Nursing Guide
Thank you to Dr. Olga Jarrín Montaner of the Latino Nurses Network for her collaboration and shared resources on this article.
Andrés Fernández, born in Palos de la Frontera, Spain, was a part of the small Catholic Obregónian brotherhood in the early 1600s and served as a nurse with the brotherhood in Madrid General Hospital. The brotherhood (or Hermanos Obregones) was known as the Minimum Congregation of the Servants of the Poor, or Minimum Congregation of the Poor Nurse Brothers, whose members initially fed the sick, made beds, and buried the dead in the early hospitals and convalescent homes of Madrid. The congregation was formed by Bernadino Gómez de Obregón(1540–1599) in 1568 after he decided, at the age of 27, to sell everything he owned, leave his property to relatives, and cast off his noble lineage and devote himself to the care of the sick and poor instead. Obregón was entrusted by the Spanish monarchy of Felipe II to became the administrator of Madrid General Hospital in 1587. In addition to serving in the hospital, members of the brotherhood were also sent to serve in prisons, during military operations, and across regions of both Spain and Portugal.
The text Training Nurses and a Method for Applying Remedies to all Forms of Illness (or Instrucción de Enfermeros y Método de Aplicar los Remedios a Todo Tipo de Enfermedades) was first published in 1617 as an 82-page guide to train those in the brotherhood in clinical nursing care. For over a century the text was widely used and ultimately made it’s way to the New World as Obregonian brothers were present on trans-atlantic travel to provide nursing care on shipping vessels during the era of Spanish exploration and colonialization.
For purposes of this English-language article, much of what is known and presented here about the content of the text authored by Fernández is thanks to an English-language dissertation published by Australian nurse PhD Tanya Gai Langtree in 2020 — links to Spanish-language sources will also be included below. Dr. Langtree states that re-discovery of these training books are due to the findings of a postgraduate history student, Antonio Garcia Martinez, who unearthed the treatise while working in the archives of the University of Seville in Spain in 1989 (page 17).
Senior Brother Fernández is listed as the primary author for the second, third, and fourth editions of Instrucción de Enfermeros. In the second version, published in 1625 and expanded to 232 pages, and he stated in the edition’s introduction:
“And so it seemed a very fair thing to show, and teach others what I learnt in my twenty-four years of experience … learnt from very learned and experienced doctors’”
A total of five versions of the text would be published through 1728 which would become peer-reviewed by leading doctors, the Spanish monarchy, and the Church. Fernández and the brotherhood worked to improve the physical environment of patients, care for the convalescent poor, extend care throughout the kingdom, and adequately train nursing staff. Below we will include translated aspects of the text as found in Dr. Langtree’s dissertation to illustrate the nursing knowledge by Fernández and the brotherhood during the seventeenth and early eighteenth century. Below is a list of nursing interventions and considerations from the second edition:
The text presented more than 40 nursing interventions for respiratory infections, skin conditions, plague, smallpox, burns, measles, and dozens of other common medical conditions recognized today:
The text additionally included a theoretical approach to clinical thinking:
According to Dr. Langtree, in studying the translated second edition, she:
“was amazed at the similarities between how Fernández described the principles and practices of Obregonian nursing and how we currently teach undergraduate nursing students the fundamentals of care. Fernandez expected his nurses to not only know how to perform a skill, but also to possess the reasoning for performing it. He expected his nurses to conduct themselves at a consistently high standard, yet also recognized the barriers that impeded their ability to provide quality nursing care.” (page 2)
Analyzing the Instrucción de Enfermeros for her research led Dr. Langtree to “question why, as a profession, are we largely unaware of our history prior to Nightingale-era nursing…[I] wanted to learn if and how this unfamiliarity with the past has affected current constructs and issues in nursing” (page 2). Few sources cover the professional or personal biography of Andrés Fernández besides his authorship of the Instrucción de Enfermeros, but sharing the rich legacy of this early Spanish nursing text should be a commitment of the profession in order to expand the origin story of nursing knowledge and practice. For readers seeking a reproduction of this foundational nursing text, the Spanish-language version is currently available from Amazon and two Spanish-language articles on Andrés Fernández as author and another on the Instrucción de Enfermeros can be found here,
Sources
Unless otherwise linked, the information above was sourced from the PhD thesis Notes on Pre-Nightingale Nursing: What It Was and What It Was Not and from the article “What a nurse suffers”: Care left undone in seventeenth-century Madrid, adopted from the thesis.
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Learn More
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Know Your History
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- American Association for the History of Nursing to attend monthly webinars on topics of nursing history, view the calendar here.
Examine Bias
- NurseManifest offers live zoom sessions with fellow nurses on nursing’s overdue reckoning on racism and a page to sign their pledge.
- Breaking Bias in Healthcare is an online course created by scientist Anu Gupta, to learn how bias is related to our brain’s neurobiology and can be mitigated with mindfulness.
- Revolutionary Love Learning Hub provides free tools for learners and educators to use love as fuel towards ourselves, our opponents, and to others so that we can embody a world where we see no strangers.
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- Critical Conversation on Health Equity and Racism Toolkit from the American Academy of Nursing
- National Coalition for Ethnic Minority Nurse Association to stay engaged with topics relevant to nurses of color.
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