The District Nurse in our Society Anthony J. Carr, SRN, NON Cert., QN, MRSH, AIHE Midland Area Organizer, Rcn

Trained nurse, health educator, friend he suggests, is not readily recognized of the family-this is how the author by the public-or by her own colleagues sees the district nurse, but her position, in hospital

It may seem unnecessary to many nurses to nurse patients in their the public, and in the pro- district nurses to be reminded of the own homes. I do not, intend to fession .as to the training and ex- position they hold in their own com- survey the development of' district perience of the district nurse. munity. .On reflection, however, I nursing in this country-its beginnings While the Minister of Health is think they will agree that it is profitable in Liverpool with the Rathbone launching a national campaign for for all professional nurses to pause family, and the connections of Florence recruiting student and pupil .nurses every so often and make a reassess- Nightingale with the first projects of and projecting a true image of nursing, ment of their personal contribution, district nursing. What I would men- perhaps the local authorities may be away from' the 'pressure of daily work. tion is the fact that a district nurse is a persuaded to' correct the image of the The main purpose of this article, State-, holding in most district nurse with their own local which is divided under six simple cases the National District Nursing publicity. headings, is that everyone should Certificate and/or on the roll of the' I personally have 'lost count of reassess her own position in the city, Queen's Institute of District Nursing. the number of times district nurses town or village in which she works, She may of course hold other quali- have recalled incidents to' me, like and within her own community. fications-manyare qualified mid- being told by grateful relatives, 'But I wives and practise this together with my dear, you are so good at nursing I I The Trained Nurse district nursing. The question I put is why don't you go into hospital like I Many nurses will immediately say simple: Do the public, the patient's that nice 18-year-old girl down the l that this particular point needs no relatives, or the patient himself know road and train to be a proper nurse?' elaboration. May I remind them that this? There are so many tales told of Perhaps the Sarah Gamp image is t there still remains appalling ignorance; district nurses being mistaken for more closely linked to district nursing both in the hospital service and among someone' else. In my ,career as a than the ho~pital service. ' the public at large, of the 'training and Queen's nurse I have even been shown skill required to become a district electricity and gas meters by well- The Pioneer- nurse. meaning relatives. Perhaps the uniform The district nurse was one of the Since 1887 the Queen's Institute of and Gladstone bag do not help the first workers in the .public health District Nursing, as it is now known, male Queen's nurse ..The fact remains, field. Following the influence of Edwin has prepared and equipped hospital there is gross ignorance on the part of Chadwick and the Public Health Act I I I I

of 1848, the first district nurse made Even today the district nurse is a education departments of the local her appearance. This was in 1859 in pioneer. General practitioners are authorities influence the community Liverpool. The Acts of Parliament of experimenting with having district by lectures, films and advertising and 1902 and 1936 helped the pioneering nurses on their staff. I am led to make a true and real contribution to spirit of this service, by granting believe that this is a successful venture positive health the district nurse has registration to midwives and later for both professional staff and patients a very ready access to the public. She providing a national midwifery service alike. It is right that a service with such is invited into people's homes as a under the local health authority. Miss noble beginnings in pioneer health very welcome guest, and they are Nightingale wrote of district nursing work should again be showing the willing to carry out her instructions. in 1876,'The beginning has been made, public and health professions the The nurse herself may feel she is the first crusade has been fought and immense contribution district nurses getting nowhere with a particular won to bring a truly national under- still have to make. family, but often sees small signs like taking, trained nursing to the bedside being offered a clean towel when all among the London sick poor in the The Health Educator the others used in the household are only way in which real nursing can be It .is becoming more readily recog- dirty. She then realizes that she is brought.' nized that the district nurse is in a setting a standard of positive health G. M. Trevelyan's Illustrated English very good position to carry out daily • which will to some extent be accepted. Social History*, Volume 4, describes health education among the large During her visits all sort of questions the background against which pioneers section 'of the public she comes into dealing with health and illness are began to care for the poor and sick. contact with every day of her working. asked and advice is readily taken. *Penguin, Ss. 6d. each life. While it is true that the health This i~ particularly true when the • NURSING TIMES JANUARY 28 1966 III

nurse's home is in the same area. I have lost many an evening with my family because a neighbour has a problem with a child or relative, perhaps not serious enough to call a doctor but still giving some anxiety to 'the family. True, an evening lost to leisure, but a positive gain in the field of health education. Being. in the patient's home gives the nurse this distinct .advantage over all other vworkers in the field. Relatives will . readily co-operate in many things _because the nurse is providing the t very necessary' support they need' ~during the illness of their loved one.

The Perhaps it is not readily recognized by the nursing profession as a whole 112 NURSING TIMES JANUARY 28 1966

This article is based on a lecture given at a refresher course for district nurses at the Rcn Birmingham Centre of Nursing Education I

that the responsibilities undertaken by objects, his family and friends. He is general practitioner but also the home I the district nurse are considerable. It is more- sure of himself' and the nurse help service, the national assistance she alone who decides how and when in turn has to have a much more department and the welfare officer. the patient shall be nursed. It is her personal approach. She can see The priest and vicar form part of the decision and responsibility in advising very quickly the financial well-being or supporting staff as do the WVS meals- and training relatives to care for the otherwise of the household and, when on-wheels service, and the chiropodist patient during her absence. She has to relatives are unde·r stress, she can and . The mental welfare make many decisions on her own help to give the will to fight and officer, the psychiatric social worker which involve just as much courage recover, and help to sustain physical from the local authority, and- the and professional competence as any and emotional levels within the house. medical social worker from the colleague needs in the hospital service. It has been my personal experience hospital, together with the physio- Medical cover is less on the district that the nurse who silently sheds a tear therapist and occupational therapist, than in hospital, so the doctor deperids after the relatives have left the bedside make their own important contribution very much on the accurate observation Of their departed loved one, or to the patient's recovery: The district of the nurse if his time is to be put to expresses her deep emotional feelings nurse is a very important link with the best possible use. The doctor to a colleague after visiting a young these and other specialists and knows respects the skill and training of the wife or husband in the last stages of a that her place is firmly established nurse. Let no mistake be made, the terminal illness, is one who can feel within this vast team. district nurse is a highly trained she is in touch with real life. It is just nursing practitioner in her own this essential emotion that drives the Conclusion rights. nurse to give more than her best for her It has been the aim of this article to patient. place the district nurse in a particular The Friend of the Family It has also been my experience that position in society. It will be seen that There is, I fear, a solemn belief in many senior public health nurses are she is a well trained nurse practitioner the nursing profession that any very much more approachable than. in her own rights. She is in a position emotion felt by the nurse towards a their counterparts in the hospital that demands great skill, initiative and patient' is a veri singular weakness service. Is it that they have experienced perseverance. It has also been seen that and must be completely eradicated as also the humbling that comes from this position is not always readily quickly as possible. It is further looking after ill people in their own recognized by the public or, unfor- 'suggested that to carry out treatment homes? Doesthis give them greater tunately, by her own colleagues in the efficiently, one has to be completely understanding of the problems of their hospital service. She has been viewed detached. I personally can find very own staff? as an ambassador with a message of little time for 'the point of view that the positive health and with a pioneer nurse should be completely unaffected A Member of a Complex Team spirit. by human tragedy and remain coldly The district nurse would be the first But it is .the individual district detached from reality. The district to recognize that she belongs to a nurse, and she alone who can find her nurse sees her patient in a much more team of valuable workers that gets true field of influence, and assert it personal atmosphere than a hospital. more complex every year. She works with fV11authority for the good of her At home he is surrounded by familiar in close harmony not only with the own community ..