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1910

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The
Trained
Nurse

and Hospital Review

BOSTON MEDICA

JAN 27138

LIBRARY

January
Number, 1908

Lakeside Publishing Company
114-116 East 28th St., New York

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Hospital Review

VOL. XL.

NEW YORK, JANUARY, 1908

NO. 1

The Nursing of People of Moderate_Means* From the Viewpoint of the Physician

FRANKLIN W. BARROWS, M. D., BUFFALO, N. Y.

YOU have conferred a privilege upon

me by your friendly invitation to speak to you to-day, and you have thrust a responsibility upon me by requiring me to represent the views of the profession to which I belong. I thank you for the privilege. At this moment it remains to be seen whether you will have cause to thank me for assuming the responsibility.

As usual, the nurse and the doctor have met together to consult about the patient, and, as usual, the patient is to have nothing to say about it to-day, although he may have his say later. There are more than two sides to every question -this has three. And while you and I are expressing our concern for the patient we know very well that beneath it all is a deep and strong undercurrent of concern for ourselves and our kind. This is right. It is the thought that inspired the counsel, "To thine own self be true, and it must follow, as the night the day, thou canst not then be false to any man.' If we tackle the problem before us in this spirit we will find that in the last analysis the interests of the patient, the nurse and

the physician must harmonize, because they are identical.

In order to treat this problem honestly and eliminate my own personal bias in so far as possible, I have invited the cooperation of some fifty or more physicians, selected somewhat at random, and representing all sections of the United States. In order to bring out most directly the facts and opinions germane to the problem, the following questions were propounded:

I. Do you know of many people who are, financially or otherwise, unable to secure the services of trained nurses in the event of illness, and who cannot be considered as objects of charity?

2. Do you think that trained nurses as a profession are performing their duty to this class of patients? If not, why not?

3. In your experience what caremedical and nursing-do these sick ordinarily receive, and at about what expense?

4. Would it be feasible for your hospitals to care for all these cases at an equal expense per patient? Please explain your answer.

5. In your opinion what is the most *Read before the New York State Association of Nurses, Syracuse, October, 1907, and Contributed to THE TRAINED NURSE.

feasible plan for improving the status of this class of patients, so far as nursing is concerned?

6. Do you wish that I should regard your answers as confidential, or are you willing that I should quote you?

Over forty physicians took sufficient interest in these questions to send me their replies. These have been carefully

collated and will form the basis of this

paper, which I would like to have you consider a symposium rather than an expression of my personal views. As I have received permission, I shall not hesitate to quote freely from these letters whenever it seems appropriate,

rather than use words of my own.

In reply to question 1, three-quarters of the answers give positive evidence of the existence of a large class of people, not usually ranked as dependents, who are unable to secure the services of the

trained nurse in time of need. One physician says that four-fifths of his patients belong to this class; four others place the proportion as high as ninety per cent. A woman physician in a large city writes: "I am in that very class myself."

Only two doctors, a country practitioner in Nebraska and another country practitioner in Western New York, answer this question with a decided No." They both add, however, that the distance of the farmer from large cities, not his poverty, makes the employment of trained nurses almost impossible except in cases of "dire necessity."

It is, therefore, totally unnecessary to assume that a considerable proportion of the sick are, under present conditions, out of reach of the trained nurse. We know that this class exists in almost every community. It may be in order, however, to inquire who they are and how we may know them. As the stand

A

ards of living are not the same in all communities, so, of course, the significance of the phrase "moderate means" changes in passing from place to place. A Chicago physician, in explaining this term, says: "I mean men employed in commercial establishments, tradesmen, small store keepers, even a certain percentage of professional men, etc.” woman practicing in a large industrial city says: "All persons who are supporting a family on $8 to $15 per week would come in this class." We note also that it is not always the lack of money that prevents these people from employing trained nurses. It may be that the family lives in one room, or that for some other reason it seems impossible to house the nurse, though we must hasten to admit that frequently the friends of the patient exercise wonderful originality and fertility of resource in contriving places for the nurse to sleep, if, indeed, it be thought necessary that she should sleep at all.

Before considering the second question, the obvious duty of the nurse to these unfortunate people, it will be best to proceed to the discussion of questions 3 and 4.

The replies to question 3 generally state that, so far as medical attention is concerned, these patients receive as good treatment as those of any other class. In many cases the physician collects his regular fee; in most cases he discounts his fee twenty-five to fifty per cent, and sometimes he gives his services without charge.

The nursing of these cases, on the other hand, is usually performed at little or no expense to the patient, by friends and relatives-"anxious and overworked members of their families," as one doc

tor puts it-or, according to another, "some old woman that can be had for her board or very small compensation, the older woman commanding the greater confidence providing she isn't blind or lame enough to need a cane." In this connection one of our city correspondents reminds us that nursing by friends and neighbors "has gone out of fashion, making the care of the sick a problem for the trained nurse, physician and family to solve." Doctors are generally disposed to condemn the kind of home care just alluded to, although often obliged to put up with it and even to assist in it by teaching and admonishing the amateur as occasion seems to demand. Several doctors speak appreciatively of the eagerness and cleverness with which such ex tempore nurses-especially young mothers receive every bit of instruction, but as a general thing they judge the amateur nurse by our modern high standards of nursing, and pronounce her incompetent.

If an effort is made to secure a paid nurse for the patient of moderate means, it usually results in hiring an untrained woman with more or less practical experience, as the phrase is, or some one who has taken a part of the regular training school course, or one of the products of the correspondence school

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attendant. Several of my correspond

that

ents, however, testify that these nurses are very good; one physician—a woman, too-says that her $12 practical nurses do better work under her personal direction than the trained nurses with whom she has been associated; while several other physicians affirm these nurses are worse than none at all. From all the evidence we are certainly justified in concluding that the really competent practical nurse is usually in such great demand that she asks and receives almost the same, if not just the same, wage as the trained nurse herself, and for that reason she, too, is out of the question in families of moder

ate means.

A few of the cases under consideration are fortunate enough to go to the hospitals for $8 to $12 per week. Others employ well trained hourly nurses at fifty cents to $1 per hour and thus receive excellent service. A few accept the offices of trained nurses supplied to them by churches, societies, lodges, etc., and thus become, for the time, recipients of charity. In a few rare instances the trained nurse donates her services.

The majority of our correspondents would undoubtedly subscribe to the opinion of Dr. A. T. Bristow, of Brooklyn, that "there is no economy in employing nurses other than the regular trained nurse." It follows, then, that the class. of patients under consideration are paying very dear for a very inferior service in the line of nusing.

Let us see now, in considering question 4, whether we can reasonably ask the hospitals to care for all these sick people without increasing their burden of expense. About 15 per cent of the physicians answer this question in the affirmative. Several believe that all surgical

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