Visiting Nurse Service Administered by the Henry Street Settlement (1936)
Henry Street Visiting Nurse Service Administered by the Henry Street Settlement
Headquarters: 99 Park Avenue, New York, October, 1936
Some years have passed since the Henry Street Visiting Nurse gave a comprehensive report of its activities to the public which it serves, and from which it derives its support The Story of the increased demand for nursing service and how it has been met during these lean years is told in this report. Because the friends of the Henry Street, old and new, have continued to give as they could, because the nurses themselves have shouldered added burdens with never-failing devotion and loyalty, the Service has been able to meet that demand.
What the skill and care of these devoted nurses has meant to thousands of the needy sick, of all ages, during these dark times, no statistics can reflect. Home nursing, such as ours, includes health education to the family as well as care to the patient. The charts and facts presented in this report enable those previously unfamiliar with our work to understand in some small measure the significance of the Service. Those whose contributions are supporting it and in whom its continuance depends, will, we feel sure, find an abiding satisfaction in the results in human value which their generosity has made possible.
The Nursing Committee
By Mary Schieffelin Brown, Chairman
It has been said by public health authorities that about 2% of the population is ill at one time. This would seem like a small percentage until one realizes that New York City alone houses 7,000,000. There are, therefore, at this very important moment, about 140,000 people in this city who are sick! Of these, 112,000 or 80% are ill in their own homes.
Why People Stay at Home
There are many reasons why these people, though ill, remain in their homes. Often it is because hospitalization is not necessary, but many times it is because it is not available. When a patient is suffering from grippe, influenza, cancer, or diabetes, hospital care is not always essential. Should the patient be a small child, it is often inadvisable. Pediatricians agree that home care is the best for a child, except in case of severe illness, as the psychological effects of unfamiliar surroundings is often a deterrent to recovery.
The Visiting Nurse Provides Care in the Home
To safeguard the health of these patients, adequate medical and nursing care must be provided in the homes. The Visiting Nurse Service, working with the physician, is prepared to meet the nursing needs of these families. Only graduate registered nurses are employed and these nurses have had special public health training. Each staff nurse makes visits daily to people of all creeds and color. To the patient who can afford to pay for this service, there is a charge of $1.25 per visit. For those who can pay nothing at all, the service is free. An appointment service at a higher rate is maintained for patients who need treatment at a special hour.
In 1935, the staff of the 264 Henry Street Visiting Nurses gave care to 99,362 patients in the boroughs of Manhattan, Bronx and Queen. To these people they made 517,016 visits.
In ten years the service has increased by 170,00 visits–in thirty years it has increased by 475,000. Dr. S.S. Goldwater, Commissioner of Hospitals in New York, has said, “The chronic diseases constitute the major health problems of today.” The interpretation of this statement and its tragic significance can readily be seen by a glance at the chart on the opposite page [Six Chief Causes of Death] which shows that five of the major causes of death are due to chronic diseases and one, the sixth, pneumonia. No effort has been made, even in symbol, to soften the shock which its study brings.
More heartening are the reports culled from the Nurses’ files which tell a story of prolonged life through their daily ministration. To a bewildered family nothing is as confusing as the difficult procedures which must often be followed in caring for those who suffer from these illnesses. It is often only the nurse working with the physician to make instructions clear, who can gradually win the family’s confidence and bringing them aid and comfort.
To 12 year old George, the nurses brought this gift of prolonged life. A cardiac for seven years, no one dared to hope for his survival. When the nurse was called, George was acutely ill. After many discouraging weeks of patient care, George began to improve and when he had recovered sufficiently, the nurse arranged to have him admitted to a special hospital for further care. When improvement there warranted it still further, she sent George away for convalescence and he returned strong and able to go back to school. Now, only occasional welfare visits have to be made to keep check on George’s health.
“REGULAR EXAMINATIONS”… “EARLY DIAGNOSIS!” How often these distress signals have been sounded by medical science! Yet despite them, thousands of people die annually of cancer which could have been prevented if early symptoms had been recognized and treatment started.
The Visiting Nurse has a rare opportunity in case finding, for sometimes she is the only one to whom a worried person confides the fear of suspicious symptoms. To Margaret Cardo, daughter of a cancer patient, the nurse brought guidance and the care which [as written on graphic “The Six Chief Causes”] helped her “from going crazy.” She wanted so desperately to do the dressings for her Mother, yet she fumbled and could not do them. After two visits, the nurse had taught her by simple method. Even Margaret’s mother, through observation, learned to do them for herself. When Margaret’s confidence had been completely restored she urged the nurse to visit Mrs. Jones, her neighbor, who “had one of those mysterious lumps also, but was too scared to go to anyone.”
Pneumonia is one of the prime causes of death in New York City. In 1935, about 14,000 patients had this disease. In some homes as many as four and five people were suffering from it at the same time.Pneumonia Cases cared for by HSVNS[View Image]
Pneumonia Cases cared for by HSVNS
The Henry Street Visiting Nurses cared for 28% of all the pneumonia patients reported to the Board of Health in the boroughs of Manhattan, Bronx, and Queens. Some of the cases were of such a desperate nature that even the doctors despaired of their recovery.
One such instance came to the Visiting Nurse who was called in to see a child who had been ill with pneumonia for eight days before a doctor was summoned. “Do what you can,” said the doctor, after examining the little girl whose mouth was so swollen that she could take no food at all. “But I can give little hope, for the child has been totally neglected for more than a week. She’s too sick to be sent to a hospital.” The nurse answered, “What are your orders?” “General care, special attention to the mouth, and a glucose enema every two hours. Make at least two visits a day.”
The Importance of Health Education
For many days the Henry Street Nurses gave the treatment prescribed, and taught the mother how to carry on in her absence. Soon she brought the child’s mouth back to a condition where she could take nourishment normally. Then the mother was taught to prepare the special foods which she obtained from the School Fund and a welfare agency.
After weeks of care, the little girl had recovered and the nurse made arrangements for the child to leave her tenement home for convalescence in the country: In three months, she was back at school.
The Henry Street nurses are in a position, in homes of this kind, to teach someone in the household the basic rules of hygiene. Some of the simplest formulae of good living are daily being violated because of lack of understanding, and to these people, the nurse brings the message of health, interpreting its application for her patients and the community.At everybody's service[View Image]
At Everybody’s Service
When Mrs. Fargus called the nurse, she did so only because the doctor “had recommended” her. The mother was tired and discouraged and had lost all hope for her six year old Billy who was in a coma…
“I don’t think you can do anything for him, nurse,” she said “because he won’t even let me come near him. His right hand is terribly swollen and it hurts him if I touch it. But I have to move him to wash him and feed him, and then he gets irritable, and if I scold him he vomits. I don’t think anyone can do anything else for him.”
The nurse explained how sensitive to touch that swollen hand was, and why the slightest jar put Billy “off” for the day. And as she worked she showed Mrs. Fargus how to care for Billy and explained the importance of her attitude in the boy’s eventual recovery. Later, when Billy was greatly improved, she procured the help of a visiting teacher to give him new interests and continued supervision to help prevent a recurrence of this disease.
Though great advances have been made in the reduction of tuberculosis, it is still a great menace to public health, because it is the highest cause of death between 15 and 45, the most productive period of life. Therefore, early discovery of the disease is vital, and the Henry Street nurses are constantly on the alert to discern tell-tale symptoms and to send their patients to a physician for medical treatment.
Very often the discovery of a tuberculous patient is quite unexpected, as in the case of Louisa, a 2 year old child who used to come to Mothers’ Club with her mother. While the nurse discussed plans for the new baby, she noticed the listless child, who had dark circles under her eyes, and a worried expression.
The nurse asked the mother to take Louisa to a doctor for examination. The x-ray and Mantoux test showed tuberculosis!
Through the nurse, arrangement was made for a long stay for Louisa at a sanitarium, and after several months she returned rosy, bright eyed and full of life.
It is estimated that there are 100,000 diabetics in New York City, and that 2% of the country’s population will eventually die of this illness!
How the Nurse Helps Control It
One of the most direct avenues of relief to those who suffer from this illness, is through the Visiting Nurses. In the control of diabetes, the patient must be encouraged and made to understand the importance of diet. She must be taught to give herself the insulin injections that are so vital, if there is no one else in the family to do this for her. But for the elderly people, those who live alone, and to those whose poor eyesight cannot permit of this self-injection, the Visiting Nurse must give treatment.
Recently, the nurse was called by a neighbor to “do something for my neighbor who groans all the time.” When the nurse investigated she found this woman had left the hospital where she had been told that amputation of the foot was necessary because of fear that the same verdict would be given.
The nurse finally persuaded the family to call a physician and finding him most sympathetic and understanding, they were willing to carry out his advice. He gave the nurse her orders for the care of the wound and asked her to make the patient “especially comfortable,” as recovery was doubtful.
The outlook was discouraging. The only help in the family was from the son, who was a longshoreman. The nurse was skeptical about his ability to give care to his mother in her absence, even though he was devoted to her. But under the nurse’s guidance his huge awkward hands soon learned the delicate technique of dressing and the treatment to stimulate circulation. Finally, he was able to take over the entire care, reliving the nurse for other cases.
When the nurse stopped in some months later, the patient herself opened the door. With pride, she took off her shoes to show how the wound had healed.
More and more families are learning to depend on the helpful instruction of the visiting nurse in caring for children suffering from communicable diseases so prevalent in childhood. In 1924, the nurse gave care to 8% of all the reported cases of whooping cough, measles, diphtheria and scarlet fever in the three boroughs covered by the Visiting Nurse Service. Today, this number has increased to 14%.
Families who call on the visiting nurse to assist in the care of patients suffering from communicable diseases, learn to assume responsibility for the prevention of the spread of contagion. An important factor in the control of disease is the cooperation which the nurse is able to secure from other agencies. The following story illustrates this well.
Scarlet Fever and a Housing Problem
Angelina’s family lived in a congested tenement district. the home consisted of five rooms, plainly furnished, but exceptionally clean. The nurse was called to visit Angelina, the six year old girl, seriously ill with scarlet fever to whom the doctor had offered his services gratis because the family could not pay for medical attention. With a neighbor interpreting, the grandmother who spoke no English was instructed in isolation technique, Eager to learn, she listened intently as the nurse explained that Angelina’s care affected not only herself, but every member of the family. Everything progressed nicely, the nurse and grandmother holding daily conversations in sign language. There was only one difficulty. Both the grandmother and Angelina refused to have the window in the back sick room opened.
It was many days before Angelina explained why. “I am so afraid of the rats outside my window,” she said. The nurse looked out, and she saw three huge rats on the small roof adjoining the window. The grandmother opened the window, threw a pail of scalding water at them and they ran off the roof, jumping to the yard below.
When the nurse investigated, she learned that the unsanitary condition of the dumbwaiter shaft was the cause of these conditions. The dumbwaiter ropes were broken and all the tenants threw their garbage into the shaft, where most of it adhered to the walls. The nurse took the matter up with the superintendent but when she could accomplish nothing through him, she referred the matter to the Health Department and Tenement House Commission. they responded promptly, and conditions improved.
So too, the nurse sees many social and economic factors which have much to do with the health of the family. She detects mental and emotional disturbances in their early stages and directs her patients to available psychiatric resources for study and therapy. She must also be thoroughly acquainted with the social and health agencies in the neighborhood so that she may guide those of her patients who are just starting to show symptoms of the maladjustment and tension, to sources of help, such as clubs, settlements, family case work, relief agencies, physicians and hospitals.
One of the most important functions of the Henry Street nurse is to act as parent educator in the homes she visits, by talking over with troubled parents, methods handling the behavior difficulties which are encountered in all homes where there are growing children. Upon the nurse’s understanding of normal human reactions and family relationships, depends to a great extent the success or failure of the nurse in her capacity as a teacher of both physical and mental health.
Recently a nurse was called to see a new baby, and after the visit the troubled mother asked for advice about her oldest boy, George, a thin and undernourished child of twelve, who was fast becoming sullen and impudent. In school he refused to study, failed in all his subjects and was left to repeat his grade. At home he was irritable, disagreeable and disobedient. He was the oldest of nine children. Formerly the mother had been able to depend upon him, and had given him the care of four other little boys and girl. As soon as George came in from school he had taken the children to the playground. But now he had not had one free minute in eighteen months.
His mother said he had always accepted his responsibility until this last spring when he had repeatedly rebelled. When he was forced to take the children he was unkind to them, teased them and sent them home crying. When he came home, his mother would whip him and send him to bed, but she said this punishment would do no good for he became more sullen and more impudent. Then she would have his father whip him “until he hollered good.” But no amount of punishment helped.
The nurse discussed some of the problems of “growing up” with the worried mother, and shortly after this visit she secured an invitation for George to go to camp. He was made Junior Counselor and voted “Best all-around sport.” When he came home he had gained seventeen pounds. He started school after one month’s attendance his teacher had him skip a grade.
The nurse then discussed additional plans with the mother and father. She induced George and his young brothers to join boys’ clubs at a Settlement. He was made responsible for bringing the little boys to the settlement and for taking them home. this he did willingly and cheerfully, even with pride. Now his school teacher reports marked improvement in academic work and in deportment. He is happy and well and his mother and father are delighted with his behavior at home.
In the three boroughs of Manhattan, Bronx and Queens 59,616 babies were born in 1935! The Henry Street Nurse visited nearly 30% of the mothers at some time during pregnancy, some before the baby arrived and others after it had come.
Often the nurse is called in the only after the patient has been dismissed from the hospital, to teach the mothers how to give good care to the newborn baby and to train him in good habits.
For the regular staff at Henry Street a planned introduction to public health nursing is given, and in addition, through supervision, conferences and lectures, an educational program is continued during their entire service in the organization.
Experience in Supervision
The Henry Street Visiting Nurse Service has provided a four months’ program for especially qualified staff nurses which will give them experience in supervision. In addition, our assistant supervisors have four month’s experience which prepares them for teaching and the administrative duties of supervisors.
Teachers College, Columbia University, has had affiliation with the Henry Street Visiting Nurse Service for many years, using this organization as the initial training center for their students of public health nursing. Fordham University has recently made a similar affiliation. College credit toward a degree is given by both universities for this experience.
Henry Street is also planning with Teachers College to give field experience to nurses coming in under the Social Security Program.
Since 1917, field experience for undergraduate student nurses has been provided. At the present time in New York Hospital School of Nursing, Bellevue, Harlem, Lincoln, Mount Sinai, Presbyterian, Roosevelt and St. Luke’s Hospitals are sending students.
Important Positions Filled
Many of the leading figures in nursing today received public health experience in the Henry Street Service. Among them are the directors of large visiting nurse services all over the country, directors of official public health agencies, and professors of public health nursing in our universities.
Henry Street nurses are working all over the world. This is what they say:
Japan: “ I always feel proud that our work here in Japan is modeled after Henry Street Visiting Nurse Service. Though small in its scope yet, I am copying almost every phase of your work.”
From Persia: “…and that is why I am glad I am a nurse in Persia, for if nurses can do this in America we can for Persia.”
From South Africa: “My association with Henry Street has been one of my most valued experiences in nursing.”
From China: “Whenever I am confronted with a problem I think, ‘How did they handle this at Henry Street?”
Condensed Statement of Income and Expenditures January 1 1935 to December 31, 1935
Contributions . . . . . . $304,747.35
Fees for Nursing Service paid by:
Insurance and Industrial Companies 194,422.38
New York City Home Relief Bureau 39,702.00
Patients . . . . . . 16,257.75
Income from Investments . . . . 79,542.56
Total Income . . . . . . . $634,671.04
Salaries: Nursing Staff including all
Supervision . . . . . . $506,395.94
Clerical Staff in 20 Centers-Statistical
and Financial Headquarters . . . . 66,455.90
Clinics . . . . . . . 528.46
Expenditures other than Salaries:
Rent, telephone, equipment, medical and surgical supplies, building up-keep,
stationery, postage and office supplies, transportation, insurance and sundry
unclassified expenses . . . . $64,435.15
Total Expenditures . . . . . . $636,815.44
Excess of Expenditures over Income . . . .$ 2,144.40
Source: University of Minnesota, Twin Cities, Social Welfare History Archives. Minneapolis, MN: https://www.lib.umn.edu/swha
How to Cite this Article (APA Format): Henry Street visiting nurse service administered by the Henry Street Settlement. (1936). Retrie[date accessed] from /?p=9492.