This material is part of a report which Miss Vogel compiled while enrolled in a field course in the Division of Nursing Education, Teachers College, Columbia University, New York City. The field work was done under the direction of the Henry Street Visiting Nursing Service, and many of the techniques described represent those used on that service. Practical features follow in subsequent numbers of the series. D. L. B.
If any profession is to meet the demands of the public, which incidentally licenses it for that purpose, it must give consideration to whether it is fully and satisfactorily meeting these needs. Is the public-health nurse cooperating with the hospital, so that the patient's services there will be a natural outgrowth of the home care he has thus far received ? Does the patient place greater weight on hospital "orders" because of the orientation the public-health nurse has given him? Is he impressed that the hospital and his visiting nurse are united in an endeavor for his recovery ? Likewise, when he comes to the hospital, is he made to feel that this huge building with its strange atmosphere is but an extension of the kindly concern of his visiting nurse? Does he leave the hospital with knowledge of how to meet the newly created problems ? If these questions can all be answered in the affirmative, truly a near-Utopian state of affairs exists. Toward this ideal, nurses both. in public-health work and in hospitals should be intelligently and actively striving.
The aim of every good school of nursing in graduating professional nurses is defined in part as follows : "All professional nurses should be able to co-operate effectively with the family, hospital personnel, and health and social agencies in the interests of patient and community."1
Upon graduation, student nurses do not understand community problems and how they may best meet these problems unless the "community viewpoint" has been woven throughout their basic course from the entrance into the school of nursing until commencement.
If a desirable integration program is carried out, it should be started at the student's entrance into the school, and with her first subjects. Since the Nursing Arts course forms the core of the curriculum, it would seem desirable to introduce whenever possible with each new procedure, a simplification of the procedure which might be executed in the home, with the same efficiency and safety to the patient as are assured in the hospital with Its much more elaborate equipment.
Nursing literature has contained various simplifications. Why are these in need of greater emphasis today than formerly ? The answer is that there is a recognized need for more and more public-health nurses, and evidence seems to indicate that new graduates are choosing this field in greater numbers. Should not these prospective public-health nurses be somewhat acquainted with the work they plan to enter, so that choices may be more wisely made and adjustment may be easier ? And a still greater reason for a knowledge of simplifications is that every student nurse should be alert to each opportunity for instructing the hospital patient in the simple ways in which he can care for himself, using in most cases equipment already in the home.
There is a growing recognition among nursing educators that teaching is a responsibility in every aspect of the nurse's work.' The best teaching can be done only when the one who teaches is acquainted with the prospective student as an individual, and as a member of his family and his community. The learner, or patient, never is an isolated unit. Likewise, teaching which has been effectively grasped and utilized by the learner will affect the circle of individuals with whom he is acquainted.
It would appear that in some instances, hospitals in their effort to be "efficient" and "routinized" often obscure the student nurse's vision of the patient as an individual—an individual in need of sympathetic analysis of his problem as relates to the final health objective. Certain parts of the routine work can be done by less-skilled individuals. It seems that the student nurse's sole purpose in the hospital is to become educated so that she may in turn effectively restore the patient's health and prevent its subsequent failure.' A nurse who is unaware of his most important responsibility has missed an unusual opportunity.
How may the student be made to realize this unique opportunity ? If possible, by some contact in a home, a patient's home if this can be arranged, where simple equipment must be used. In this way the using of appropriate vocabulary and simple equipment is necessitated. When the student returns to the hospital surroundings, in a very real fashion she is prepared to use the right vocabulary in explaining to a patient how he is to carry out a technique in a simple manner, to achieve the results which in the hospital are obtained with more elaborate equipment. Thus the importance of simplifications.
Eight Tests by Which to Judge Simplifications
Simplifications are not makeshifts. They are attempts "to make less complex" the elaborate hospital techniques which often must be more in detail and longer, to prevent cross contaminations. The following criteria would seem to be valuable in judging the efficacy of any simplification:
1. It must be safe for the patient.
2. It must be based on scientific principles.
3. It must be present in the home, be readily procured or easily contrived.
4. It must be financially attainable.
5. It must conserve time, effort, and materials.
6. It must be easily cleaned or disposed of.
7. It must be capable of being understood by the individual in the household who is to use it.
8. It must be effective for the particular use to which it is to be put.
It is hoped that the student may through this added emphasis on home procedure gain a clearer insight into community needs as they are related to her nursing education, while still carrying on her basic course. This should then be more nearly an educative experience,' in that the situation set up in the Nursing Arts demonstration room will more closely approxifnate that of a home than a mere verbal rehearsal of what might be found in the home situation.
There is no attempt to go into the exact sequence of procedures; only the differences or variations that will have to be made in hospital technique, as they are adapted to home needs, are noted.
_______ To be continued in October
Committee on the Grading of Nursing Schools, "Nursing Schools—Today and Tomorrow," pp. 67 ff. New York City, 1934.
Tittman, Anna L., "Employment in Nursing Today," American Journal of Nursing, 39 :46, January, 1939.
Jensen, Deborah M., "Nursing Care Studies," Macmillan, rogo, pp. 26, 27.
Webster's Collegiate Dictionary, third edition. 'Dewey, John, "Experience and Education."