Monday, June 20, 2011

The next installment...

From Rebecca:

This week we arrive in Liverpool, England circa 1859 and the creation of the first of district nursing program, upon which Abbie Howes and Phebe Adam modeled the Instructive District Nursing Association of Boston in 1886. William Rathbone VI (Feb 1819 – Mar 1902), of the Rathbone family featured in last week’s blog, is considered to be the founder of modern district nursing, and the focus of this week’s post.

In 1859, Rathbone’s first wife became gravely ill and he hired a nurse, Mary Robinson, who came into their home and greatly eased the pain and suffering of her last days. It occurred to Rathbone that this service would provide tremendous relief to the sick poor whose difficult and harsh lives often prevented them from seeking medical care. He asked Robinson if she would be willing to take part in a 3 month trial of nursing the sick poor in their homes, a pilot which he would organize and fund. She agreed and Rathbone set about arranging for the necessary equipment, medicines and nourishments.

Given his familiarity with the situation of the poor citizens of Liverpool, he believed the district nurse would have the greatest impact if she not only attended to the immediate physical ailments of the patient, but also took into consideration their social and family situation as well. His vision was that the nurse would not simply provide short-term relief, but that she would also plant a seed of long-term and widespread improvement by educating the patient and the family to caring for their own sick and instill in them the importance of healthy living and the principles of proper hygiene.

After just one month of work, Robinson asked Rathbone to be released from her contract. Although she was accustomed to sickness and death, the level of suffering and squalor she faced in serving the sick poor of Liverpool was overwhelming. She felt that her efforts were hopeless and were dwarfed by the level of need. Rathbone urged her to continue, and tried to impart in her his belief in the tremendous positive effect her work would have on the lives of those she cared for. “He showed her how much relief from suffering her care brought to the sick; how her teaching and example, must, in time, bear fruit; and that the satisfaction of knowing she had been instrumental in putting even a few families on their feet, and of blazing the path in a new field of work, would compensate her for all her present discouragements” (Brainard, The Evolution of Public Health Nursing, 1922, p 108).

Rathbone’s strong belief in the merits to the plan convinced Robinson, and she continued through her 3 month contract at which time Rathbone’s hopes were fulfilled. She was able to see her success in not only addressing the immediate ailments of the patient, but also in achieving permanent improvements in their health and standard of living. Also, in many cases, the improvement were not limited to the patient, but also their families, whose well being depended on the presence of both a mother and father as caretakers and breadwinners, and also on the community who saw the positive impact on their neighbors and changed their own behaviors. Thus it was at the end of the three month period, Robinson resolved to make district nursing her life’s work.

Rathbone felt confident that his experiment had amply demonstrated the potential benefit district nursing would bring to better the health and stability of those whose grim lives were often shadowed by loss and despair; people who would have otherwise been thought of as hopeless cases. Rathbone was determined to expand the service, but faced several barriers, including the skepticism of his peers. The prevailing opinion was that the problems faced by the multitudes of low-wage workers were insurmountable and that it would be a hopeless exercise for a nurse to try to make a difference. Also, many in the medical community did not believe that proper care could be provided in the busy and dirty conditions of the home and suggested that a hospital was only appropriate venue for care. And, even if Rathbone could convince people to support the project, finding a supply of trained nurses to provide this service throughout the impoverished districts of Liverpool was going to be almost impossible.

Next week we will see how Rathbone overcame these difficulties through a deep and persistent belief in the usefulness of the plan, by widely sharing his enthusiasm for the effort and by turning to Florence Nightingale for help and advice. Rathbone and Nightingale ended up becoming close friends each with a great admiration and respect for the work and ideas of the other.

Saturday, June 18, 2011

Congratulations to our very own Boston Bruins!

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Me and a million of my closest friends descended upon the streets of Boston today to congratulate the Stanley Cup Champion Boston Bruins!!!  Pictured here, Series MVP, Tim Thomas.

Tuesday, June 14, 2011

More of the VNA of Boston story...

Here's the next installment of the story... from Rebecca:

In 1859, Liverpool was a well established port city pulsing with commerce and industry. The population exploded in the 200 years between 1700 and 1900 as immigrants and waves of workers from the countryside flocked to the city, drawn by the demand for labor created by the industrial revolution and trade of all sorts. Our interest is in the Rathbone family of Liverpool, a family of prominent businessmen and philanthropists, and in particular in William Rathbone VI who established the first modern District Nursing organization in 1859, upon which our agency was modeled after in 1886.

The original William Rathbone brought his family to Liverpool in the early 1700s to pursue opportunities for his family in this growing port city. Initially, he worked in a saw mill and in 1742, at the age of 46, he established his own timber business, Rathbone Brothers. Subsequent William Rathbones (there are 13 generations now) built on this foundation and grew the family business, expanding into the cotton trade, shipping, ship building and eventually merchant banking.

From the beginning, the Rathbone family had a high sense of social consciousness and each generation engaged in significant public service and philanthropy. The early Rathbones were Quakers and Nonconformists, meaning they rejected the governance of the Church of England and were advocates for religious freedom. They consistently opposed the slave trade, which was a major part of business in Liverpool. At its peak in 1799, 40% of the worlds’, and 80% of Britain’s slave trade passed through Liverpool’s ports.

William Rathbone V and his wife Elizabeth, the parents of the our William Rathbone, expanded on this work and were large supports of Kitty Wilkerson’s efforts to provide people with a place to wash their clothes and bedding during the cholera outbreak of 1832. (the result of which was the establishment of the first public baths and wash-houses in Liverpool) The famous American prison and mental health reformer Dorethea Dix spent a formative year living with the William Rathbone V and his wife in the late 1830s. While there, she met a group of men and women who advocated for government involvement in social welfare and learned about the British lunacy reform movement, whose methods of detailed investigation of madhouses and asylums she applied to her work on reform for the care of the insane poor upon her return to Massachusetts in 1840. At their deaths, obituaries said of William and Elizabeth Rathbone: "His name was a 'household word', synonymous with truth and honour and charity” and "Her life was one of constant, careful, conscientious helpfulness, on a scale that can have no record".

William Rathbone VI, the founder of modern District Nursing in Liverpool, was born in 1819 and was a partner in the family business, Rathbone Brothers and Co, from 1842 to 1885. Throughout his youth he was surrounded by the reform and philanthropy work undertaken and supported by his parents. Later in life he wrote that he regarded wealth and business success chiefly as a means to the achievement of public and philanthropic work and he wrote that after meeting the reasonable living expenses of himself and his family, a man’s wealth should be considered "a trust for which he owes an account to himself, to his fellow-men, and to God; it is not an absolute freehold which he may use solely for personal enjoyment and indulgence."

Next week, I will delve deeper into William Rathbone VI’s achievements and the Liverpool District Nursing organization, arguably his most far reaching effort that has had long term influence on nursing in England and the United States.

Tuesday, June 7, 2011

What is a public health dental hygienist?

Here's an important initiative sponsored by the Massachusetts Department of Public Health.  VNA of Boston's own Barbara Belony is a member of the Senior Oral Health Working Group and appears a few times in this video.

Kevin Youkilis, Red Sox third baseman, stops by to say hello

Youk (aka Kevin Edmund Youkilis) has won a Gold Glove, played in two All-Star games and been a member of two World Series Champion Red Sox teams. 

And he's a nice guy.

Shown here with some of our All-Star VNA of Boston managers...

Friday, June 3, 2011

The VNA of Boston story continues...

Here's the next installment from Rebecca...

In this posting, I continue to share the historical insights I’ve been gleaning from reading Annie M. Brainard’s 1922 book, The Evolution of Public Health Nursing. As we enter the 1800s, we observe how the evolution of public health nursing from a service of the Church to a more independent function sets the stage for the entrance of public health nursing as an important component of the modern health care system in the early 1900s.

The Modern Deaconess Movement

It is said that travelers from Protestant countries would return home with stories of the wonderful care given by the Daughters of Charity, the ancient sisterhoods of Beguines and other groups of nursing sisters, the match of which was not to be found in their own countries. So great was the need for similar services that in 1815 an English doctor called for an order of women to be created, who like the Daughters of Charity would be “selected for good, plain common sense, kindness of disposition, indefatigable industry and deep piety; let them receive - not a technical and scientific – but a practical medical education.”

His call was not heeded in England, but in 1822, Theodor Fliedner, a young Lutheran pastor, established a Protestant sisterhood in the German town of Kaiserswerth. Inspired by an order of Mennonite deaconesses he had observed while visiting Holland and also by the work of Elizabeth Fry, a prison reformer in England, Fliedner and his wife created a Women’s Society with the mission of visiting the sick poor in their homes. Like his predecessor Vincent de Paul, he realized that the wealthy ladies interested in giving charity were not particularly suited to the work. So, as with de Paul, he sought out women of the working class with an interest in the vocation of helping the poor and nursing the sick. Fliedner took his organization a step further and provided these women with three years of training before they could be named Deaconess. Fliedner garnered great international respect and his most famous pupil was none other than Florence Nightingale. Nightingale first visited Kaiserwerth in 1846 as a crusading health care reformer, and was so favorably impressed that she later returned to enroll in Fliedner’s program, graduating in 1851.

On a side note, while researching information on deaconesses I stumbled across an article about Boston’s Beth Israel Deaconess Medical Center. I learned that the New England Deaconess Hospital (which later merged with Beth Israel) was founded in 1896 by a group of Fliedner’s deaconesses whose first 14-bed infirmary was opened in a converted five-story brownstone at 691 Massachusetts Avenue, not so far from the VNABA’s office at 561 Massachusetts Avenue (KELLY – I assume we were at 561 in 1896 yes?)

In Conclusion…

As I continue to study the history of visiting nursing and how the VNABA has grown as an organization, I will be interested to see how the roots of visiting nursing, so steeped in the culture of charity, underlie our modern identity and how we are perceived as a profession. I can’t help feeling that there must be a tension between the business entity we are today and the charitable efforts provided by our predecessors. There is a theme which runs through Brainard’s book; that the modern public health nurse is still animated by the same “spirit of service to mankind” that motivated the early deaconesses and sisters through the centuries. Even though Brainard proposes modern ideas of organization and business she still frames the career of a nurse as more of a calling or vocation rather than simply as a profession or gainful occupation. I am sure this partially reflects the time in which she was writing, but I do wonder how much our modern perception of nursing as a career still harbors an unspoken expectation that the choice to be a nurse goes beyond that of merely choosing an occupation and crosses into the realm of engaging in a “service to mankind” and if so, is there a resultant blurring of the line between the personal and the professional in the role of nurse which still persists today?

Thursday, June 2, 2011

Make Way for...

Ducklings, Bruins and Nurses.

"Make Way for Ducklings" is a fantastic children's picture book, first published in 1941 and written and illustrated by Robert McCloskey.  The book chronicles the story of a pair of mallard ducks who decide to raise their family on a small island in the pond at nearby Boston Public Garden.

In October of 1987, a bronze statue depicting Mrs. Mallard and her eight ducklings was placed nearby that same pond.  The work was by local artist, Nancy Schon.  I understand that there is a similar piece in Moscow (gift of Mrs. Bush to Raisa Gorbachev in 1991).

Through the years, some have had fun with the sculpture, including dressing them up to commemmorate the fact that our Boston Bruins (last night's loss... ugh) are in the Stanley Cup Finals for the first time in over 20 years.

The photo below is a clever photoshop version of the ducks in honor of our great nurses.

Wednesday, June 1, 2011

The "daunting prospect" - a report from the field...

This is a guest post from Janice Sullivan, our VP of External Affairs.  As part of a management initiative to make sure we all stay well connected with the purpose and mission of our organization, those of us who tend to be tethered to our desks are making sure we go out on home visits with our clinicians on a regular basis.  Here's what Janice had to say:

I had the opportunity to go on home visits with Roberta Dillon, RN, on a hot, humid day last week. Roberta’s “neighborhood” is in the Mattapan area of Boston. As I trailed after her, up the stairs to yet another un-air conditioned apartment, watching as she lugged the tools of her trade, laptop, BP cuff, thermometers and whatever else was carefully packed in her black bag, it hit me again….our clinicians do amazing work and help people who really, really need their expertise.

And again, I wondered at all these initiatives the federal and state governments are putting out there to encourage providers and payers to “contain costs” by coordination of care in less expensive settings. Why not just support (you can read that as “pay fairly”) home health care agencies like the VNA of Boston who do this work and do it extremely well.

Roberta picked me up in the neighborhood and I rode around with her all morning. She knows her way around the community and is a whiz at balancing driving, taking calls (hands free of course, wink), taking notes and keeping it all together – and she doesn’t drive slowly either. Some visits were more complicated than others, watching Roberta work with an older women (96) with dementia, and who was not at all happy with us being in the house, was a tutorial in diplomacy as Roberta convinced her to get a dressing changed that absolutely had to done.

I know we take care of plenty of younger patients, but what struck me was that aging with failing health is a daunting prospect. Aging, and trying to manage the various aspects of the health care you need is an even more daunting prospect. And aging, perhaps with some dementia, and trying to figure out the myriad of caregivers and providers involved in your care looks like it could downright impossible. Even with a constant caregiver in the house, and I met two husbands who could not have been more protective and tender with their wives, those primary caregivers are often not in the best of health either.

That’s where I think the VNA of Boston comes in….Roberta, in more than setting, called the doctor, assessed fall risks, answered questions about the home health aide, reconciled the medications, organized the pharmacy delivery, you name it….she was the manager of the healthcare team. Transitions in care, reducing re-hospitalizations, care coordination, geriatric care management are all buzzwords these days. In my opinion, that wheel does not need to re-invented – it exists at the VNA of Boston and needs to be supported by payers, including the government, not duplicated with all the costs associated with developing new infrastructures. Clone Roberta and others like her -- that may save thousands in a day.

VNABA Traveling Display in the Community at Grove Hall

The VNABA Traveling Display recently appeared at the Grove Hall branch of the Boston Public Library. Our thanks to head librarian Paul Edwards, who graciously hosted the event.

I'm pictured next to two nursing students and then on their sides by two of our own nurses, Keren Diamond (far left) and Adele Pike (far right).  Carol Bourne, also of the VNA of Boston, is third from the right and librarian, Paul Edwards is next to Adele.

This is part of our effort to celebrate our 125 years of caring out in the community and near those whom we serve...