Round Table Conference

Kai Tiaki : the journal of the nurses of New Zealand, Volume XVII, Issue 4, 1 October 1928, Page 179

Round Table Conference

Miss Bicknell : This afternoon has been set apart for various members who have written papers to read them, and that we should then discuss them. The papers are under the heading of "The Education of Nurses." The papers will be read first and then be open for discussion. The first paper is one dealing with "The Affiliation between the larger Training Schools and Smaller Hospitals," to be read by Miss Tennent. Miss Smith will discuss the points raised by Miss Tennent and after she has done so the paper will be open for discussion. Miss Smith discussed the points raised by Miss Tennent.

NURSING EDUCATION—PRELIMINARY SCHOOL. On looking* over the field of nursing in New Zealand and noting improvements made, my attention is drawn to one particular phase of our work where certain departures have been made from the ordinary methods, and which seems to me worthy of careful consideration. I refer to the establishing of Preliminary Schools for preliminary training. What is of great interest and value to us at present is the growing recognition of the fact that some such preliminary instruc-

tion is necessary and that attempts are being made under many difficulties to provide it. Whatever form this instruction may ultimately take in the training of nurses in New Zealand hospitals, I think it may be now reasonably looked upon as part of good education in nursing. The problems in nursing to-day are manifold, and some of them are very conspicuous, but it does not seem to me that they differ from the problems with which every profession has to struggle. Now that preliminary training for nurses has come to stay, I would suggest that there should be some uniform scheme for this training. Could not this matter be taken up and discussed at the forthcoming Matrons' Conference, thereby obtaining the views of the majority, of matrons in charge of training schools? 1 would also suggest that tutor sisters attend this conference.

Uniformity should be found in the selection of subjects, allotment of time to each method of teaching, and in suitable tests of the student's knowledge, and this can only be decided upon by those in control of the Training School in couiunction with those directly responsible tor the teaching. Up to date, there are only four preliminary schools in New Zealand, one in each of the main centres, but so far the small training schools (50 beds and under) have not yet been able to benefit in this way. The time has come when something should be done to enable pupil nurses of small hospitals to also receive some such training. ft has been suggested that a way in which this could be carried out is by arranging for these nurses to attend the preliminary schools of the larger hospitals. This is quite possible, but would require a great deal of serious consideration. Briefly this would mean absolute co-operation and loyalty, together with definite standarisation of all subjects to be taught in the school and period of training.

As Miss Tennent stated, hospitals sending nurses would be responsible for board, salary, uniform, travelling expenses, etc., during their stay in the Preliminary School. It would be less expensive for them than paying a tutor full time, and may be funds would help the bigger hos-

pital in the upkeep of the school ; in fact, it might prove a paying proposition. In the second suggestion, regarding Preliminary Schools that they should not be entirely apart from hospitals, but should be under the supervision and control of the Medical Superintendent and Matron of the hospital to which they are attached, although in separate buildings. This school would be self-contained, pupils living in and being responsible for practically all work done therein. 1. A Preliminary School, wherever it may be, cannot possibly be a success unless one person can give full time to it. 2. That one person cannot possibly satisfactorily cope with more than 10 pupils (maximum) at a time. I prefer six. Xo definite report can possibly be given on a nurse's work until she has had some ward experience, and then must be given in conjunction with the ward sister, i.e.. if the school is only of three weeks' duration. It should aid in being a sorting place for unsatisfactory nurses. Examinations should be set and corrected and practical work examined by some one other than the preliminary tutor. Syllabus would depend a great deal on the length of the school period. Although the preliminary school is the commencement on which a sound basic training is to be built to support a structure that will stand during the whole of a nurses's professional career, no matter what branch or branches she may choose to take up, it by no means takes the place of a systematic and continuous ward teaching. Nothing can take the place of this kind of teaching, and the whole employment of lectures, classes and demonstrations is merely preparatory or supplementary. The main body of teachingshould be done in the w^ards, and that should be carried out in a far more satisfactory way than is now generally the case. In large wards this is a verv different matter for the busy ward sister, who is not only expected to teach nurses, but responsible for the administration of her ward and numerous other responsibilities. It is particularly difficult in hospitals where a medical school is attached,

as a great deal of time is taken up with students' clinics. I would like to suggest here as a remedy for this, the increase of senior staff to help to overcome this difficulty. For example, the appointment of a staff nurse or deputy sister for not less than six months in the same ward. Her duty hours to alternate with sister in charge. In the Dunedin Hospital the preliminary course is three weeks, and during that time I attempt to teach the pupil nurses what I think will be of most use to themselves and most helpful to the ward sisters. Only a very limited curriculum can be gone through in three weeks. My curriculum of to-day is a very much shorter one than when I began this work two years ago, finding from experience that it was better to stick strictly to the work the nurse would actually be doing in her first few months rather than trying to cram in as much as possible. I also endeavour to keep the preliminary teaching from becoming too theoretical. Theory is a very necessary thing, but not quite the most important asset in nursing. Curriculum Used. Pupil nurse's duty hours, 9 a.m. until 5 p.m. Out of that time comes their meal hours. They do not come on duty on Sunday. Home Sister instructs the nurses re their responsibilities as regards the Nurses' Home, i.e., meal hours, laundry, care of their rooms, etc., etc. 1. Introductory lecture. Explanation of hospital rules, etiquette, etc. 2. Qualification of a nurse. 3. Bandaging (practice given daily if possible). 4. Hygiene: Ventilation, sanitation, care of sick room or ward. Cleaning, care of linen. 5. Reds: Different kinds and their uses. Use of cradles, bed blocks, sandbags, sputum mugs, etc. 6. Care of hot water bottles. 7. Personal care of patient, including bed bathing, care of the mouth, teeth, hair, backs.

8. Ward Reports: Their uses and importance. Care of patient's belongings, admission of patient. 9. T.P.R. Chart marking. 10. Saving of specimens. 11. Observation of stools and urine. Rules in giving a bedpan. 12. S. & W. enema. Vaginal douche. 13. Surgical cleanliness. Care of instruments. 14. Care and cleaning of rubber, china and enamelware. 15. Administration of medicine. 16. Feeding helpless patients. 17. Care of the dead. Theory, practical work and demonstrations arranged to give best possible benefit to nurses. During the last week the pupil nurses go to the wards for two hours daily. Lectures on history of nursing and eithics given by Miss Tennent. Interchange of Nurses for 3 Months During 3 Years 9 training. I do not consider it a workable proposition at all. It would mean a break in the continuity of training and teaching, which would be far more detrimental than advantageous. Would probably mean a great deal of individual attention for the exchange nurse, thereby taking away from one's own nurses. There would be a change in teaching which would be difficult to overcome and which would tend to leave the nurses rather muddled. In both instances it would probably take the nurse most of the time accommodating herself to her new surroundings and different administration, and the much sought for co-operation between the hospitals would fail. I most certainly support the exchange of nurses after completing their three years. There would be many advantages on both sides. Nurses from large hospitals receiving an insight into the administration life in general of a small hospital ; nurses from small hospitals receiving experience in special departments, such as out-patients, etc. ; administration when dealing with large numbers. Under our present hospital system in .New

Zealand it seems that many small hospitals must exist, therefore must be staffed. Until this present situation can be altered in the way of centralisation of hospitals every facility should be afforded these nurses in small hospitals (under 50 beds) to further their experience. It would necessitate a four years' training all round to allow of this.