Read Ebook: Nurses' Papers on Tuberculosis : read before the Nurses' Study Circle of the Dispensary Department Chicago Municipal Tuberculosis Sanitarium by Chicago Ill Municipal Tuberculosis Sanitarium Dispensary Department

Font size: 10 px 15 px 20 px 25 px 30 px 35 px

Background color: BlackWhiteGrayLight GrayDark GrayDim Gray

Text color: BlackWhiteGrayLight GrayDark GrayDim Gray

Apply/Save settings

Ebook has 464 lines and 31151 words, and 10 pages

In 1903, the first visiting tuberculosis nurse was assigned in Baltimore to follow up patients of the Johns Hopkins Hospital Out-patient Department. Her duties were varied as are the duties of the present day tuberculosis nurse. She was to instruct patients in the use of sunlight and fresh air and was allowed to furnish them with special diet in the shape of milk and eggs. She investigated home conditions and helped improve sleeping quarters. She placed patients in sanatoria, or brought them back to the dispensary for treatment. She gave bedside care to advanced cases, if she could not get them into hospitals, and applied to relief organizations for help in solving the problems of the family. From time to time other nurses of the Baltimore Visiting Nurse Association were assigned to the work, other dispensaries and agencies began referring cases to be followed up, and the work grew to such proportions as to be almost unmanageable for a private organization.

In 1910, the Tuberculosis Division of the Baltimore Health Department was organized. It began its activities with a corps of fifteen nurses and a visiting list of 1,617 patients turned over to it by the Baltimore Visiting Nurse Association. The object of the Tuberculosis Division was to bring under the supervision of the Health Department all persons in the city suffering with pulmonary tuberculosis. Ambulatory cases were to be given advice and instruction; advanced cases, bedside care, if needed, or hospital care, if available. At present, it is upon the advanced cases, as well as those who are in contact with them, that the nurses of the Tuberculosis Division concentrate their efforts. The Staff at present consists of a Superintendent and sixteen Field Nurses. The city is divided into sixteen districts, a nurse being assigned to each district. Each nurse is responsible for the care of all cases of tuberculosis in her district.

In 1912, the Tuberculosis Division opened two municipal tuberculosis dispensaries. These dispensaries receive patients on alternate days from 3 to 5 p. m., nurses in districts nearest the dispensaries alternating for clinic duty. Other dispensaries are the Phipps Tuberculosis Dispensary at Johns Hopkins' Hospital, and the University of Maryland Hospital Tuberculosis Dispensary.

The problems which chiefly concern the Tuberculosis Division in its efforts to control the spread of tuberculosis in Baltimore are the failure of physicians to report cases to the Department of Health until the patient is in a dying condition, and the inadequate provision for hospital care of advanced cases. These conditions are particularly marked in the case of colored patients, who are found going in and out of homes, restaurants, and laundries, as cooks, waitresses and servants of various kinds, as long as they are able to drag themselves about.

The nurses of the Tuberculosis Division are graduate nurses and are registered. They are paid a month, with car fare and telephone expenses, and are allowed two weeks' vacation with pay. They are not required to take a Civil Service examination, but are carefully selected with a view to obtaining women of a high grade of efficiency. They wear uniforms of blue denim with simple hats and coats, but not of uniform design. Each nurse wears under the lapel of her coat a badge reading "Nurse--Baltimore Health Department," which she uses on occasions. The nurses report to the Superintendent each morning at 8:30 to hand in reports of the previous day's work, to stock their bags, and to receive new work for the day. At noon each nurse reports at her branch office, of which there are seven, each situated on border lines of adjoining districts. An hour is spent at the branch office for lunch and rest, for receiving telephone calls and for restocking the bags for afternoon rounds. The nurse leaves her district at four o'clock to attend to about an hour's clerical work, which is usually done at home.

The average number of patients per nurse is 212, about four per cent of whom are bed cases. These bed patients are visited two or three times a week, while ambulatory cases are visited on an average of twice a month. During the year 1912 the sixteen nurses made 72,058 visits for instruction and nursing care.

NEW YORK

The oldest tuberculosis clinic in New York City is connected with the New York Nose, Throat and Lung Hospital; it was established in 1894. In 1895, the Presbyterian Hospital established a special tuberculosis clinic. In 1902, the Vanderbilt Clinic organized a special class for the treatment of tuberculosis. In 1903, Gouverneur and Bellevue Hospitals and, in 1904, Harlem Hospital added Tuberculosis Clinics. These were followed during the next few years by the establishment of many others. In 1906, when the Tuberculosis Relief Committee of the New York Charity Organization Society began its work among the tuberculous poor of the city, it met at every turn instances of overlapping and duplication in the work done by the various clinics. This lack of co-operation, with the resulting difficulties encountered by the Committee in its endeavor to efficiently administer its special tuberculosis fund, demonstrated the advisability of forming an organization having as its object the co-ordination of the work of the various tuberculosis clinics. In 1908, nine of these clinics and several allied philanthropic agencies were organized into the Association of Tuberculosis Clinics. Today there are 29 clinics, 14 philanthropic institutions and organizations, five departments of municipal and state government, six tuberculosis institutions, and numerous other institutions and organizations having special interest in tuberculosis work. Of the 29 clinics, eleven are under the supervision of the Department of Health, three are connected with city hospitals, and the remainder are operated by private institutions. This voluntary association of private and municipal dispensaries, sharing equal responsibilities and acknowledging equal obligations, is a striking feature of tuberculosis work in New York and presents a unique example of co-operation.

The task of standardizing the clinics was a difficult one. One clinic had ten rooms with every convenience. Another had one room and no conveniences. Some clinics made no provision for sputum beyond a cuspidor; others provided gauze or paper napkins when patients entered the room. Two clinics provided no drinking water; two had a metal water cooler in the waiting room; one provided sanitary drinking cups; and another had two enamel drinking cups chained to the wall. Some clinics had sanitary fountains; in others the nurse kept a glass on hand for the patients. Neither was there any uniformity in matters of dress. Nurses and doctors at some clinics wore ordinary street clothes. At other clinics, gowns or aprons, with or without sleeves, were worn. Three clinics occupied separate buildings of their own. Four clinics provided separate waiting-rooms for tuberculous patients. At one dispensary the tuberculous patients had the use of the general waiting room, there being no other clinics held at that time; other clinics made no distinction, tuberculous patients using the general waiting room in company with patients attending other clinics. After studying the conditions existing in the various clinics, it was decided that to belong to the association each clinic must subscribe to and comply with the following regulations:

a. Tuberculous patients must be segregated in a separate class.

b. Home supervision of all cases by a graduate nurse especially assigned for this purpose must be maintained.

c. Each dispensary must serve a certain district, and all cases living outside of this district must be transferred to the clinic serving the district within which they live.

Early in the history of the Association objection was made to this last rule by teachers of medicine, who held that it tended to deprive them of teaching material; but they soon fell in line with the other dispensaries when they saw the advantage it afforded them of improving their methods without loss of teaching material, and the further opportunity of securing home supervision.

From time to time it has been necessary for the Association to adopt certain methods of procedure in the administration of the various clinics. The general policy of the Association is as follows:

Each clinic should arrange for a physician to visit and treat in their homes patients who are too ill to attend clinic, for whom hospital care cannot be provided.

Special children's clinics should be established wherever the size of the clinic warrants it.

Sputum of every patient should be examined once a month; patients should be re-examined once a month, and the results entered on the records.

The physician should use the nurse's report of home conditions as a basis for advising patients.

Patients refusing to attend the proper dispensary shall be dismissed as delinquent and reported to the Health Department.

All supervising nurses should be affiliated with some local relief organization in order to better organize the relief work of the clinic.

The home of every patient should be visited at least once a month.

The classification of the National Association for the Study and Prevention of Tuberculosis should be followed for recording stages of disease and condition on discharge.

A uniform system of record keeping should be used by nurses in order to facilitate the compiling of monthly reports.

The staff of physicians should be sufficient to allow at least fifteen minutes for the examination of every new case, and at least six minutes for every old case.

There should be at least one nurse for every 100 patients on the clinic register.

Sputum cups, or a proper substitute, should be furnished to patients to take home.

Paper or gauze handkerchiefs should be given to each patient on entrance to the clinic.

No cuspidors should be used.

Sanitary fountains or sanitary drinking cups should be provided.

Gowns with sleeves should be worn by physicians. Nurses should wear gowns with sleeves or washable uniforms while on duty in the dispensary.

That the Association found it necessary to make so many recommendations for the administration of the various clinics is evidence of the diverse systems, and in some instances, the entire lack of system, in vogue in some dispensaries. The salary of nurses in privately operated tuberculosis dispensaries averages about per month; no standard uniform is in use.

The organization of the work of the new Health Department tuberculosis nurses has been based upon the district system in force among the Associated Clinics. In each clinic district a staff of Health Department nurses is maintained, charged with the sanitary supervision of cases of pulmonary tuberculosis in that district. They visit at least once a month all "at home" cases; that is, cases not regularly attending clinics, not in an institution, or not under a private physician's care. These nurses report daily at the tuberculosis clinic, which is used as a district headquarters, and there receive assignments. One nurse is detailed as Captain, or supervising nurse of the district, and acts as official intermediary between the clinic and the Department of Health. Each morning the nurse telephones to the Department of Health the daily report of her staff and of the clinic, and obtains information received at the Department regarding cases in the district. In case of death or removal of tuberculous patients from a home the district nurses order disinfection of the premises and bedding; they make arrangements for admission of patients to hospitals or sanatoria, investigate complaints made by citizens, see that regulations of the Department of Health regarding expectoration are observed, and use their authority to induce delinquent cases to resume attendance at the proper clinic. They also visit families of patients in hospitals at intervals. Each nurse keeps a complete index of all cases of pulmonary tuberculosis in her district, which is at all times accessible to nurses and physicians at the clinic.

In the Department of Health clinics, the plan is as follows: a supervising nurse who does no district work, and several field nurses, each assigned to special duties on clinic days, such as registration room, throat room, examining rooms, etc. Field nurses are also responsible for the care of patients in their sub-districts, each nurse carrying an average of about 125 patients on her visiting list at one time.

BOSTON

A staff of twenty-five nurses, working from the Out-patient Department of the Boston Consumptives' Hospital, has the supervision of all tuberculosis cases in their homes, and the follow-up work on all discharged sanatorium and hospital cases in the city of Boston.

All cases of tuberculosis reported to the Health Department, whether under the care of a private physician or not, are visited at least once by a nurse from this staff, to see that they are carrying out a proper plan of isolation.

The Boston Consumptives' Hospital Dispensary, centrally located, is open every morning and one or two evenings a week. Three or four nurses are on duty in the clinic each morning, taking histories, attending nose and throat room and preparing patients for examination. At the dispensary only a medical history of new patients is taken, the social history being obtained by the nurse on her first visit to the home. Pulse, temperature and weight are also taken at the dispensary, after which the patient waits his turn for examination. Each new patient is given an examination in the nose and throat room; old patients also, if necessary. After examination or treatment, all patients return to the general waiting room. From here each patient is called before the Chief of Clinic, who notes the general progress of the patient, the results of the last examination or any remarks recorded by the physician, and the report of home conditions as reported by the nurse. The Chief of Clinic advises the patient in accordance with the needs indicated. He makes no examinations, but sees each patient every time he comes to the clinic and is thus able to follow very carefully the progress of each patient and to advise such changes in treatment as may seem necessary.

The city is divided into twenty-two districts, each nurse being responsible for the care of all tuberculous patients in her district. The number of patients cared for by each nurse is from 100 to 180. A very small percentage of bedside care is given; far advanced patients as a rule are sent to hospitals.

Boston tuberculosis nurses do not wear uniforms. They are paid 0 a year, with no increase for length of service or efficiency.

BUFFALO

The purpose of the Buffalo Association for the Relief and Control of Tuberculosis has been to stimulate progress in fighting tuberculosis. It very modestly shares with the city officials and with private charities the credit for the work accomplished. All it claims for itself is that it has been able, and will continue, to "point the way." How thoroughly it has succeeded in this may be seen by the progress made since 1909 when the Buffalo Association made its first appeal for funds. At that time Buffalo had:

A dispensary maintained by the Buffalo Charity Organization Society.

The Erie County Hospital for advanced cases.

A day camp, with a capacity of thirty patients, supported by a group of women.

One visiting nurse supplied by the District Nursing Association.

The present facilities are:

A dispensary, open every day and one evening a week, with a nose and throat clinic, and a dental clinic with a paid dentist in attendance.

The J. N. Adam Memorial Hospital for early cases, capacity 125, supported by the city.

The Municipal Hospital for the care of advanced cases, supported by the city.

The Erie County Hospital, as before.

Tuberculosis Division of the Department of Health with two tuberculosis inspectors and six visiting tuberculosis nurses.

Share on: WhatsApp @Hash Facebook Tweet