District Nursing

Kai Tiaki : the journal of the nurses of New Zealand, Volume III, Issue 3, 1 July 1910, Page 100

District Nursing

A simultaneous wave of thought and care for the need in sickness of those whose lot stations them far from hospitals and doctors and nurses seems to have passed through many countries, especially countries with large, sparsely settled country parts, " bush/' " back-blocks/' or " cut West " as it may be. This thought has concentrated itself in each place in some brain, and become the great object of work and schemes, not always on identical lines, but running always in the same direction and to the same end — the relief and help of those who are far from the the easily obtained help of the cities. In Australia, in Canada, in New Zealand, as we take up the Nursing Journals, we see the steps which are being taken to attain this end. Let us quote from the " Canadian Nurse *' of March, 1910, just to hand. New Zealand nurses will realise that what they aie asked to do by their Registrar is just what is being demanded of nurses in the older Dominion across the seas : — " Something Worth Doing." " It is years since the women of Western Canada began to write to me about the need for trained nurses in the country districts ; and they have been writing ever since about it, and yet no oiie has formulated a plan that would meet that need. I do not mean in the least to disparage the works being done by the various orders of nurses ; but nurses must live if they aie to do the work necessary, and to live they must have money. Now, at the present time there are people on homesteads who could not pay the salary of a trained nurse, and yet such people are just as liable to get sick as those who could pay for two nurses if they wanted them. Tnen, too, there are many districts which are so sparsely settled that a nurse, even receiving the usual salary, would not get wcrk enough co enable her to stay there. But there are many people, especially women and children, in such districts, who die or become chronic sufferers because of lack of skilled attention during sickness." The writer of this article goes on to make a suggestion that tiie women of a district should form themselves into a club : " There is no need foi our we men to wait for the

Government : Let them get to work, and organise a club themselves ; a club not only for the country women, but a club for all women interested in the work. Then, with these clubs organised, it would be an easy matter tc give a few entertainments, and get enough money in the treasury to send for a trained nurse, anel guarantee her a living wage of, say 500 dollars a year, anel then have a contract with her that she is not to charge members of the club more than a fixed sum ; that she must, if possible, go wherever and whenever she is wanted ; and that the society will pay the charges where the patient cannot afford to do so." This is very interesting to us in New Zealand. It is a good scheme, but not, I think, quite so good and practical as that aelvanced by our own Registrar (Dr. Valintine). Shortly, that is — in case our readers have not already seen all that has been written about it — if in any part of a Hospital District the need of a nurse is felt, the settlers of the elistriet, who are alreaely contributing their share to the Hospital rates, have only to make an application to the Boarel of the Hospital, accompanieel with a guarantee from themselves cf a certain proportion — not more than half of the necessaiy salary and expenses of a nurse — to have a nurse sent to work among them. Provision has been made in the new H3spitals and Charitable Institutions Act, passeel last year, giving Hospital Boarels power to devote their funds, supplemented by the Government subsidy, to providing nurses for the care of the sick outside their institutions. So the settlers, who all, in their own districts, are obliged to contribute towarels the upkeep of the district hospitals, from which they are too far distant to obtain the same benefit as the dwellers in the towns, will have their share, at least in nursing care, when they need it. Now what is needed to carry out this scheme is the help of the trained nurses. The very best nurses are needed : Women of experience ; trained in medical, surgical, and midwifery nursing ; with infinite tact to eleal with all classes of the community ; with resource to make the best of means available ; with judgment to decide the best

steps to take, and with force of character, to ensure those steps being taken. A very great work lies before the nurses of the Dominion, and we want our own nurses to take the work up. There is no risk about it. A nurse is not called to start work in a place where there is doubt whether she will earn her bread and butter. She is assured of an adequate salary : /IOO a year, and £50 allowance for board, which can be had for less than that sum in the country ; whether her patients are able to pay for her services or not ; whether she has enough patients to earn so much or no. She has no anxiety as to ways or means, that is the concern of the Hospital Board under which she works, and of the Government, which gives a share towards her maintenance. She may nave busy times, wh°n she may have to press volunteers into her service ; but there will be other times when she may make holiday, and when the country people will do all possible to help her do so. Therefore she should be possessed of still another quality — that of geniality and sociability. She must be able to make herself one with the people among whom she lives ; to share their amusements as well as to soothe their pain. We hope that in the future we may be able to boast in the Dominion of a well organised Army Nursing Service, and we know that nuises are eager to enrol themselves in such a band. This " back-blocks " nursing service may not present so glittering anel attractive an appearance, but there is no doubt whatever that those nurses who join it will get to the front, and be in the thick of battle with disease and death long, long (we hope) before the Sisters of the Army Nursing Reserve are called up to serve in grim reality We have heard from Miss Amy Hughes, who was staying at Government House, Sydney, that she fears the short time at her disposal for the special purpose for which she came to Australia, viz., the organisation of Lady Dudley's Bush Nursing Scheme, will not allow her to visit New Zealand. We regret very much that the nurses of New Zealand will not have the privilege of meeting this distinguished nurse, whose work is well known to all nurses who reael the current literature of their profession We reprint the article written by her for the A.T.N A. Journal, as follows : —

" General attention has recently been drawn to the subject of District Nursing, owing to the great scheme suggesteel by Her Excellency the Countess of Dudley to ensure a supply of district nurses for the Commonwealth of Australia. Special interest now attaches to the movement in consequence of the suggestion that it should be established as a Memorial to King Eelward VII, who took a personal interest in all that affected the ultimate good of the community. It is well to note that the conditions concerning district nursing in Australia to-elay are almost identical with those which existeel in Great Britain in 1889, when the Queen Victoria Jubilee Institute was founded ; the origin of that movement being the Jubilee gift of the women of Great Britain to their late beloved Queen. The endowment fund of the Institute was thus collected by them, the contributions being largely made up of small sums of memey. In Great Britain, as in Australia at present district nursing was first established in the cities, anel there were not above 200 nurses thus employed when Queen's Nurses were started. In Canada matters were even less forward, when, in 1897, the Royal Victorian Order of District Nurses for Canada was established in commemoration of the Diamond Jubilee of the good Queen. It was found necessary practically to establish district nursing in the towns before extending it to the outlying districts. In comparison with Canada, Australia to-day possesses the great advantage of already having excellent hospitals established in nearly every small town. In Canada, these have had to be erected, as part of the scheme of district nursing. The many difficulties suggested at the beginning of both the Mother Country and in Canada, have gradually proved capable of removal, and experience alone will show how the details of the system can be best applied in the various States by local committees. The first step in district nursing is to obtain fully qualified nurses, and in Australia the nursing profession has solveel this question. The principle of registration organised by the A.T.N.A. and its sister branch, R.VT.N.A., prevents any danger of an unqualified woman being enlisted in this national service of district nursing. All trained nurses realise the difficulties to be encountered when they first leave

their well equipped hospital wards, where clean linen is unlimited, no difficulty exists in the water supply, the patients' friends are only admit teel occasionally, anel there is no trouble in carrying out the eloctor's orders. These are formidable enough in private nursing, where the surroundings of the patients are comfortable, and naturally are intensified in the homes of the less well-to-do, where frequently the common necessaries of life are wanting. It is to equip nurses to face these difficulties that the system of tiaining for a period of six months under a skilled superindentent has been instituted by the Queen's Institute in Great Britain, and the Royal Victorian Order in Canada. Nurses who enter for district nursing soon realise that there is much more than the actual treatment to be done for their patients. They become in the truest sense of the word, without false sentiment or suspicion of patronage, health missioners, as Miss Nightingale aptly termed the first district nurses. During these six months they gain experience in the practical principles of sanitation and hygiene, and are thus able to give valuable object lessons on the important questions of cleanliness and ventilation. Their knowledge of cooking enables them incidentally to give valuable hints to the mother in the preparation of the food for the family, making the most of the materials to hand, and removing many of the prejudices and superstitions concerning what is good for babies and growing children. The district nurses' attention is also drawn to their duties as citizens, and they generally by means of lectures, are thus prepared to speak wisely, as opportunity arises, on questions of thrift, temperance, and the general social welfare of those amongst whom they are working. The possession of the midwifery certificate is practically a sine qua non for elistrict nurses, as, quite apart from skilled attention, they can give valuable instruction to the mother as to her own health, and to that of her infant, before her confinement, and, in attending afterwards, educate her as to the right methods for rearing healthy children. It must be remembered that under all existing systems of district nursing, the work in no way interferes with the interests of private nurses, or those known as " visiting, or hourly," nurses. The regulations under which local committees employ district nurses provide that, while the nurse receives the full market

value of her services in the country in which she works, she is only available for that part of the community which requires skilled nursing, and is unable to pay adequate remuneration for the ordinary private nurse. An essential principle of district nursing is that the whole work is conducted under the directions of the medical profession. Tliis does not imply that a doctor must be in regular attendance, as naturally there are many chronic cases in whieh the services of the nurse are necessary, but where the doctor needs only her report on the condition of the patient, from time to time. In thus outlining the objects of district nursing, no special reference has been made to the scheme for extending this work throughout Australia, but it is beyond dcubt that the existing well organised, highly trained nurses of the Commonwealth will meet the need as it arises, in places where the services of a district nurse will be of the greatest value, not only in assisting the medical men in nursing the people, but also in promoting a higher standard of health and well-being in every home she enters. Amy Hughes. The district nurse at Uruti writes an account of a very trying case she recently had to nurse. It was a case of rheumatism, and as the patient's wife was away from home, having recently been confined, there was no one at all to look after him. He could not be brought into town, as there was an eight-hour coach journey over terrible roads, and this he could not have stood. The doctor had been communicated with bytelephone, and sent out the necessary medicines with nurse. The poor man grew steadily worse, and suffered extremely, and nurse sent for his wife to come, who said everything possible had been done. The wife arrived in time to see him before he died, and to show him his little child. This was a sad and anxious case for nurse who had the burden of such responsibility upon her ; but her reward was in feeling that but for her this poor man would have been left to suffer without those alleviations which were possible, and his young wife would have lost the comfort of knowing that in her absence her husband had tender care anel skilful nursing We cannot hope always to have a favourable result to our work ; but when we have done all that is possible' we must rest content, and not feel that our labour has been in vain.