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

by Ellen N. La Motte

Since nurses come in almost daily contact with the Charity Organization Societies it should be part of their duties to attend the local district meetings of these associations, for during the discussions which take place, the nurses are able to give most helpful information concerning their own cases, while in regard to other cases, not complicated by a communicable disease, they learn much as to the methods and theory of relief-giving. For this reason, these district meetings are useful to both nurse and agent alike; the interchange of opinion enlarges the outlook of both workers, and each gains an insight into the difficulties of the other’s work. This interest and understanding promotes good feeling, tolerance, and personal friendliness—the basis of successful team work.

General Rules for Nurses and Agents. In a small community in which there is but one nurse and no Charity Organization Society or its equivalent, it is well to form a Relief Committee, to whom the nurse may refer such of her cases as need assistance. In cities where relief-giving organizations are already established, a few general rules should govern the relation between nurse and agent; the observance of these will prevent much trouble and misunderstanding. Under no circumstances should the nurse give material assistance—neither money, food, clothing, nor anything of the sort. When these things are needed, the agent should be asked for them, and no case is so acute but that it may wait until this consultation takes place. In a city where there is no emergency or night bureau, it may be necessary to make an occasional exception to this rule, in which case the nurse may tide the patient over till the following morning, when the agent may be conferred with. Such instances will be so rare, however, that they are merely noted as exceptions to the general rule—under no consideration whatever should the nurse give any material relief.

It sometimes happens that the nurse has been given a small sum to buy food, clothing, or special articles for some of her patients. This fund was perhaps intended for a specified case, or to be used at discretion. It is wiser to give this money to the agent, with the request that it be spent (if circumstances warrant) as the nurse suggests. This course may involve additional trouble, a little extra work for both nurse and agent, but it is necessary to be extremely punctilious in order to avoid serious misunderstandings.

When a nurse has been in the work a long time, and is dealing with agents whom she knows and understands, a feeling of mutual trust and dependence will arise. Under such circumstances, both may take far more leeway than should be granted a new worker—but unfortunately this happy and comfortable state is not always reached. The safest plan is that each should follow her own line with utmost precision, being rigidly careful not to overstep the boundaries between her own and another’s duties.

For example: a benevolent individual may give the nurse an overcoat, to be used for any patient who needs it. The nurse knows a patient who is expecting to enter a sanatorium in a few days. Her first inclination would be to give him the coat and say nothing. Apparently it concerns no one but herself and her patient. In adherence to the rules laid down, however, she must first consult the agent before giving away the coat. This consultation may reveal the fact that the family (new to the nurse) is well known to the Federated Charities, and that but a short time ago this patient was given an overcoat which he sold for drink. At this time, be it said, he was not known to be tuberculous. Of course, this constitutes no argument against giving him another chance, inasmuch as he depends upon it to enter the sanatorium, but it gives the nurse a side light on her patient’s character. She should make sure that he will not play fast and loose again; also upon entering the sanatorium the physician must be informed that the man is addicted to alcohol—a tendency to be considered in his treatment.

Tuberculosis, like poverty, is a chronic condition, and the delay required for wholesome co-operation will seldom prove fatal.

The agents, likewise, should be governed by one very simple rule, which will obviate all misunderstandings and ill feeling. This rule should be—no advice, suggestions, or interference in regard to medical attention, nursing, or treatment. All this lies strictly within the nurse’s province and should be left absolutely to her. For example: if an agent enters a house and finds a consumptive, she should make no suggestions as to changing doctors, going to this or that dispensary, or to such and such an institution. If the case is already known to the nurse, the agent may consult her, and find out what plans and arrangements have been made and then aid in bringing them about. If the case is unknown to the nurse, the agent should report it at once, leaving the nurse to take all necessary steps as to diagnosis and treatment. Grave results often follow the abuse of this one simple rule. For example: an agent enters a patient’s home, and finds him in charge of a certain doctor. Without knowing anything of the circumstances, she may advise him to change doctors, go to a dispensary, or even to a sanatorium. She does not know that the patient is in charge of a physician with a large private practice, and that this is the first time he has called upon the tuberculosis nurse. His co-operation and help in the tuberculosis campaign depends upon the way this first case is handled. His indignation at finding the nurse has played him false (for it is apt to be the nurse who is credited with these objectionable things) may be so great that months of explanation cannot wipe it out. As we have said before, tuberculosis is like poverty—a chronic complaint—and the delay needed for co-operation will not prove fatal.

If nurses and agents will follow strictly this one simple rule—the former to give no material assistance, the latter to offer no advice concerning the patient’s treatment—the chief cause of friction between these two sets of workers will be eliminated.

Conditions under which Relief is Asked. The nurse who visits a family every week or two is in a position to know when they have come to the end of their resources and need relief. When this point is reached, she should report the case to the agent of the Federated Charities. She must always bear in mind that her chief work is the prevention of tuberculosis; it is not necessarily the prolongation of human life, although the two are sometimes coincident. Relief should be asked for if it brings about the prevention of tuberculosis, but under no circumstances if it means increased opportunities for scattering the disease. Under the latter conditions, assistance should be withheld or withdrawn as the case may be.

For example: we have a family consisting of father, mother, and several children. The income ceased when the father, the wage-earner, became too ill to work. The family is in great need of fuel, rent, and groceries. The giving of this assistance should be made conditional upon the removal of the danger—that is, upon the patient’s going to an institution where he will be better cared for than in the home. By insisting upon this removal, the Federated Charities can play an important part in the suppression of tuberculosis.