Thursday, July 28, 2011

The VNA of Boston story continues...

Rebecca writes:

We saw in the last post that Rathbone was able to overcome widespread skepticism that any good could come of trying to nurse the sick poor in their own homes when the conditions in these homes were so desperate. He successfully argued that the nurse’s efforts would result in longer lasting improvements if she addressed the environmental problems and the treatment would be less disruptive to the family and community if the patient could be nursed in place. However, there was a second difficulty – how to find enough trained nurses to meet the great need.

Florence Nightingale returned from the Crimean wars in 1856 a highly respected and famous woman. She widely promoted her beliefs about nursing as a profession, including the idea that nurses should receive rigorous training. The first modern nursing school was established at St Thomas’s Hospital in London with the first class of nurses starting in June of 1860. The curriculum was based on Nightingale’s vision of practical nursing skills learned at the bedside, the importance of creating a sanitary environment, the ability to observe the condition of the patient accurately and an emphasis on the strong moral character of the nurse. There was also a course of study including lectures on scientific and medical topics. These nurses were known as “Nightingale Nurses”. They represented a very different type of nurse from the untrained and sometimes unscrupulous women who had been serving as nurses in the poorest districts and the workhouses. The plan was for these trained nurses to establish more schools in hospitals around the country.

At this very time Rathbone was looking for trained nurses to staff his District Nursing organization in Liverpool and wrote to Nightingale in I861 asking how he could find suitable staff. Nightingale responded that it would not be possible to send any of her new nurses to work in Liverpool full time, but that she could send one to Liverpool to establish a training school in the Royal Infirmary. Thus it transpired that Rathbone also became closely involved in nursing training and in seeing that Nightingale’s vision was implemented in training programs throughout the country. This was the first contact in what became a life-long friendship with much correspondence and great mutual admiration between Nightingale and Rathbone based on their shared concern for the well-being of the poor and working classes of Great Britain. Rathbone wrote “in any matter of nursing Miss Nightingale is my Pope and I believe in her infallibility” and that he was “proud to be one of her journeymen workers”. At his death she wrote that he was “one of God’s best and greatest sons.”

In 1881 Florence Nightingale published a booklet entitled “Trained Nursing for the Sick Poor” reflecting on the progress that had been made in the 20 years since District Nursing had begun in Liverpool. The booklet was partly a plea for funding of national training programs with consistent standards and also for homes where district nurses could live together in order to develop an esprit de corps and where their meals and housekeeping would be taken care of, similar to what was provided for nurses who worked in hospitals. She also wrote about the unique nature of District Nursing.

“A District Nurse must first nurse. She must be of a yet higher class and of a yet fuller training than a hospital nurse, because she has not the doctor always at hand; because she has no hospital appliances at hand at all; and because she has to take notes of the case for the doctor, who has no one but her to report to him. She is his staff of clinical clerks, dressers and nurses. These district nurses – and it is the first time that it has ever been done - keep records of the patient’s state including pulse, temperature etc, for the doctor.”

“If a hospital must first of all be a place which shall do the sick no harm, how much more must the sick poor’s room be made a place not to render impossible recovery from the sickness which it has probably bred! This is what the London District Nurses do; they nurse the room as well as the patient, and teach the family to nurse the room.”

“A District Nurse must bring to the notice of the Officer of Health, or proper authority, sanitary defects, which he alone can remedy. Thus dustbins are emptied, water-butts cleaned, water supply and drainage examined and remedied, which looked as if this had not been done for one hundred years.”

“Hospitals are but an intermediate stage of civilization. At present hospitals are the only place where the sick poor can be nursed, or indeed, often the sick rich. But the ultimate object is to nurse all sick at home.“

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