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

by Ellen N. La Motte

This is why “cure” is not the solution of the matter. Too few people are cured, in comparison to the numbers annually infected, to make any impression on a disease of such wide prevalence. The sanatorium, valuable as it may be for certain cases, is of little use to those who relapse upon return to an environment they will not or cannot control. This is also why mere instruction in preventive measures, unaccompanied by effective isolation, is barren of results.

Experience has taught us the unsatisfactory nature of so-called cures, and the futility of that prevention which allows the distributor of tuberculosis to remain at large in the community and heedless of his obligations. Hence we must look to segregation as the only reasonable course to pursue. If segregation can be obtained in the home, well and good. If not, then we must look to the institution to provide the proper care. This segregation, most of it voluntary, some of it enforced, is the only way to do preventive work on a scale large enough to count. To this end, we need dispensaries where the disease may be recognized and diagnosed, nurses to visit the patients in their homes, and hospitals for advanced cases, the function of the nurse being to teach patients and their families the necessity for segregating the former in hospitals.

Beginning the Work. Let us suppose that a certain community, town or country, suddenly becomes aware of tuberculosis in its midst, and in consequence wishes to get rid of it. It is but a fraction of the community which is enlightened enough for this, but from this nucleus must come all that awakening of public sentiment needed to facilitate the campaign. To estimate the number of tuberculous persons in any locality, multiply the yearly tuberculosis death-rate by five or ten—authorities differ as to the exact figures. The result will be the approximate number of those afflicted. The public press will help in disseminating this information, which is the basis from which we must work. Since the beginning of the campaign, newspapers have been wonderfully helpful allies in giving wide publicity to facts concerning tuberculosis. As a result of this newly aroused interest, an Anti-Tuberculosis Society may be created, and into its fold are gathered all those willing to help in the work, each with his dollar. Lectures, exhibits, open-air speaking, lantern-slide exhibitions, meetings in churches and others held before various societies are given in various parts of the town, and in this way information about tuberculosis is spread far and wide.

There are two classes of the community, however, that must be reached—those who have tuberculosis and those who have not. The people who go to lectures and exhibits belong chiefly to the latter class. Frequently, of course, the sick ones find their way in, in an endeavour to learn something which may be helpful to them; unfortunately, they are able to take away but little, and the little they do get they often misapply. We recall the case of a man who went to a tuberculosis exhibit, and learned that fresh air was good. As a result, he walked several miles a day in order to get it, and nearly killed himself. He had succeeded in learning one important fact—that fresh air was valuable—but another, of equal importance, that exercise was harmful, had escaped him.

To make the undertaking succeed, it is necessary to reach both the sick and the well, since that strong, intelligent public opinion, which is the motive force behind all new movements, must be aroused among the sick as well as among the healthy. But as we have seen, the former are not those who go largely to lectures, so they must be reached through some other means. The most effective way of reaching them is through the employment of a special nurse, who shall give eight hours a day, week in and week out, to visiting in the homes where tuberculosis exists, and giving instruction adapted to each individual case. By this means the people most in need of assistance are reached without loss of time and effort, and case after case is uncovered. This is shooting straight for the bull’s-eye—namely, the infected home from which tuberculosis is spread.

There may be laws on the statute books compelling doctors to notify the local health authorities of their tuberculosis cases, but these laws are not lived up to. Nor will the establishment of a hospital for advanced cases bring these patients to light; neither will the sanatorium, nor even the special tuberculosis dispensary. The surest and most effective way of unearthing them is through the visiting nurse. Therefore the nebulous plans of the newly formed anti-tuberculosis association may well crystallize themselves into a decision to put such an effective agent into the field.

Supervision of Work. After this decision has been made, the question arises, by whom is the nurse to be directed? Is she to be placed under the local health department, under a dispensary, under the charity organization society, or under the visiting nurse association, if such an organization exists in the town? If supported by a church or special association of some sort, should not the governing board of such organization direct her work? Or is she to be a free lance and manage herself?

Unless taken over by the local health department (which in that case becomes responsible for her salary and expenses incurred in the work), the nurse should be affiliated with the Visiting Nurse Association, rather than with any lay organization. Better results will be obtained if her work is directed by a superintendent of nurses who is accustomed to dealing with and judging nurses, and familiar with their duties along technical lines. The credit of supporting the nurse would still rest where it belonged—with the church, with the anti-tuberculosis association, or whatever group of people might be responsible for her maintenance,[^[1]] but this arrangement would relieve the lay organization of much responsibility, for no matter how good their intentions, such a group cannot direct nursing work as well as this can be done by one qualified for the purpose. Another advantage gained by placing the new nurse with the Visiting Nurse Association is that it keeps together the various branches of public health service, and the tuberculosis nurse realizes more fully than she otherwise might, how completely her own specialty is interlocked with and dependent upon other forms of social activity.

[1]. For five years the Maryland Tuberculosis Association supported five nurses, which it placed under the management of the Superintendent of the Visiting Nurse Association of Baltimore.

There is still another advantage in placing the new nurse with the established organization, for then a nurse may be selected with regard to her ability alone, leaving it to the Superintendent of Nurses to give her the necessary careful training in social work, and the proper supervision.