Card, four by six inches, used for summarizing the weekly and monthly reports
Examination of Charts. One of the duties of the superintendent is to examine the patients’ charts from time to time, to see how well the nurses do the clerical work, which is quite as important as the visiting itself. By carefully examining the charts, the superintendent is able to call the nurse’s attention to any lapses in them—incomplete histories, long intervals between visits, and so forth. If, for any reason, the nurse allows considerable time to elapse between her visits to a patient, the reasons for this should be fully noted on his chart. For example: some one wants to know when Mrs. Jones was last visited. On looking at the chart, we find the last visit was made on June first—and it is now August first. A two-months’ gap between visits looks like careless and inattentive work. The nurse, being questioned, however, is able to give a satisfactory explanation—Mrs. Jones had gone to pick berries, leaving the city the first of June, and not due to return till the first of September. This important fact, however, should have been noted on the chart, since it is almost as careless not to have made this entry, as it would have been to neglect the patient for so long a time. If a chart is to have any value, it should tell its own story, briefly and clearly.
These charts, therefore, should be examined every two or three weeks. It is the duty of the superintendent to go over these records, just as it is her duty to make rounds from time to time among the patients, and visit them in their homes. This is done by the superintendent, not in a spirit of distrust or suspicion, but because she is the person responsible for the work, and it is her duty to oversee it, and bring it to its highest degree of efficiency.
CHAPTER VI
Finding Patients and Building up the Visiting List—Increasing the Visiting List—Social Workers—Dispensaries—Patients’ Family and Friends—Nurses’ Cases—Physicians.
Finding Patients and Building up the Visiting List. The first thing for a nurse to do when she begins her work in a new community is to find the patients she is to instruct and care for. And the question naturally arises; how are these patients to be discovered?
The campaign of propaganda concerning the need of tuberculosis work has aroused the interest of people of all classes. The funds to support the nurse are evidence of this. But the people who pay the bills are not those who can produce the patients. To get in touch with the patients, it is necessary to approach people of another class, those whose work brings them in contact with the very poor. For, as a rule, in beginning tuberculosis work, it is only patients of the poorest class who find their way to the nurse’s visiting list. Later, as the work becomes more firmly established, and better known and understood, her visiting list will include not only the poor, but those in well-to-do and comfortable circumstances.
The Board of Managers of the new association may interest themselves in finding the patients, but in the end it is the nurse herself upon whom this responsibility rests. Upon her initiative and ability depends the success of the work. Her first step, therefore, should be to call upon all those who can in any way be of service, and who can direct her to the patients she is anxious to reach. She should call upon the physicians of the community, the dispensaries and hospitals (if there are any), social workers, such as the agents of charitable associations; priests, clergymen, and all those who come into contact with the suffering and the destitute. Her visits should be made in person, since a personal interview makes a stronger appeal to the memory of the busy man than the most convincing letter or the most eloquent report. This involves one great reason why the nurse should be thoroughly equipped in character and training; the colourless, uneducated, unconvincing woman carries with her no conviction, and inspires no confidence either in herself, or in what she proposes to do. A physician may well hesitate about turning over his patients to a woman who is unable to put her case before him.
It may be that considerable time will thus have to be spent in calling upon all those likely to know of tuberculous patients, and therefore able to furnish the nurse with the necessary names and addresses. That the response is not great should cause no discouragement. As we have said elsewhere, the tuberculosis death-rate, multiplied by five, will give a conservative estimate of the number of tuberculous individuals in a community. It is the nurse’s duty to unearth them. They exist—she must find them, and the greater the obstacles, the greater the incentive to overcome them. The total result of a two or three weeks’ campaign may be a mere handful of cases reluctantly handed over by a few physicians, and a few undiagnosed suspects, reported by an earnest priest. In this way the visiting list is begun.