The Tuberculosis Nurse: Her Function and Her Qualifications / A Handbook for Practical Workers in the Tuberculosis Campaign

by Ellen N. La Motte

The Physician’s Service. If a community decides to establish a dispensary, the first step must be to secure the services of a physician. At first this may be voluntary, and many doctors will gladly offer an hour or two of their time, once or twice a week. Should there be great pressure of work, it may be possible to find several men willing to offer their time. But however willingly and freely offered—for most physicians are generous in response to calls of this sort—it must be remembered that, after all, this service is gratuitous. The busy physician will often be obliged to side-track his dispensary obligations, in favour of urgent private calls. This is only to be expected, yet too many such side-trackings are bad for the dispensary. The patients lose confidence in it; it is discouraging for a roomful of sick people to find no one to receive them.

Experience teaches us to look askance at all volunteer work, no matter how generously or sincerely offered. Under certain conditions it may have to be accepted, but whenever possible, the physician in charge of the dispensary should be paid. It is fairer to him, and fairer to the patients.

The Health Department of Baltimore has three special tuberculosis dispensaries, each open twice a week, for two hours at a time. The physician in charge is paid a good salary, and as a result, the regularity of his attendance is in sharp contrast to that in certain other dispensaries, where the work is done by well meaning but overworked men who volunteer their services. Tuberculosis is a disease that cannot be overcome by volunteer work or economical methods.

The Physician’s Qualifications. The success of the dispensary depends upon the ability and character of the physician in charge. He should be able to make a diagnosis by means of auscultation and percussion, without hesitating to commit himself until a sputum examination reveals the bacilli.[^[7]] For if finding the bacilli is to be the sole test by which tuberculosis may be recognized, it would be possible for the nurse to obtain specimens of sputum from her patients and submit them to the laboratory direct—thus doing away with the doctor and proving the dispensary superfluous.

[7]. See Chapter IX., page [109].

Nor is this all. The physician must have a strong social sense, and be able to inspire his patients with confidence. In no other work does the personal character play so large a part, and this applies to the doctor as well as to the nurse. One of our patients, enthusiastic in her praise of one of the dispensary men, summed this up with homely accuracy: “He couldn’t have been nicer to me if I’d paid him fifty cents in his office.”

The Physician and the Patient. After the patient has been examined, the doctor carefully explains to him the nature of his disease, and the precautions necessary. Since these directions must often be brief and hurried, he will further add that he is sending a nurse to the patient’s home, to act under his orders, and see that certain directions are carried out. In this manner, the doctor prepares the way for the nurse’s visit, and gives her an authority which greatly facilitates her work. With this assistance, it is far easier to gain the patient’s confidence than if it has been forgotten or withheld. The orders concerning the patient are then given to the nurse, and if these include admission to an institution, it is her duty to arrange all the necessary details, and so relieve the physician of much time-consuming work.

Duties of the Nurse. If a community has a special dispensary as well as a special nurse, the nurse’s duties are twofold, and should include not only the home supervision of the patients, but attendance at the dispensary as well. She is the connecting link between the two. In this way, her intimate knowledge of home conditions is placed at the physician’s disposal, who is then able to give sounder advice and deal more intelligently with his patients if he has some knowledge of their environment.

The nurse’s presence at the dispensary is often a considerable assistance in persuading patients to come. Patients are often frightened and shy, and dread the unknown, consequently it is better if the nurse can give them the comforting assurance that she will be on hand to welcome them. From her knowledge of their home conditions, she also knows which cases can afford to wait, and which should be taken out of turn and given immediate attention. It is thus possible to deal with them in a personal and intelligent manner. Since at present the control of tuberculosis lies largely with the patients themselves, and depends almost wholly upon their good-will and co-operation, it is necessary to establish this co-operation as firmly as possible.

The duties of the nurse consist in taking the history of the patient; taking his weight and temperature, and preparing him for physical examination. If the patient is a woman, she must be present while this examination is made. She also gives such drugs as may have been prescribed. On his arrival, each patient receives a paper napkin to hold over his mouth during coughing attacks, and to use for expectoration. A special receptacle should be provided for these soiled napkins, and they should afterwards be burned. The nurse should come to the dispensary half an hour before it opens, in order to put it in readiness,—to take out the charts and histories, attend to the drugs, place towels and sheets in the examining rooms, and so forth. Whenever the clinic becomes large enough to require it, it will become necessary to place the clerical work in charge of a clerk.