ΑΝ

Problem IV

N anonymous letter was received by The American Journal of Nursing, entitled: "Does the Public's Attitude toward Nurses Need Educating?"

The questions put, referred to the patient's friends' attitude toward nurses, as being thoughtless of their comfort, when on cases; the question of who is right in regard to the stopping of medicines; whether the nurse is responsible for the right food being given the patient when the butler prescribes it; relations between doctors and nurses as regards orders; charges by a doctor for professional care of a nurse; having salary paid by the butler.

Some members of the public may not know

what the trained woman, as a nurse, means or how to treat her.

Is the nurse, as a trained woman, a woman of judgment and personality, as members of the public expect her to be?

Is not the public's attitude toward us, as nurses, somewhat our own fault? Is it not what some of our sisters in the profession have made it?

So far, the private duty nurse is being paid a certain sum of money for a certain number of hours of work. When nursing is placed on a professional basis, where we are giving the patients what they need, regardless of the time expended, and receive, in return, a professional fee, then perhaps we can expect a different attitude.

Accumulated problems, like these referred to, may come from those who, if not actually looking for slights, fail to exercise the tact that would prevent them.

Problem V

HEN comes the question of anonymous

ing has a rule to the effect that anonymous letters will be consigned to the W. P. B. What are your views on "Anonymous" letters and on the "tipping" of nurses?

State Meeting

Virginia: The annual meeting of the GRADUATE NURSES' ASSOCIATION OF VIRGINIA will be held at Hotel Monticello, Norfolk, May 3, 4 and 5. S. Lillian Clayton, Mary M. Roberts and Dr. S. P. Mitchell are among the speakers. A full and interesting program has been planned.

State Board Examinations Minnesota: THE MINNESOTA STATE BOARD OF EXAMINERS OF NURSES will hold examinations on May 5, 6 and 7, beginning at 9 a. m., in St. Paul, at the New State Capitol; in Duluth, at St. Mary's Hospital; in Rochester,

at St. Mary's Hospital; in Crookston, at St. Vincent's Hospital. Nurses who complete the course on or before June 1, 1927, may take the examination in May. Applications accompanied by the fee of $15 must be in the hands of the Secretary, Leila Halverson, Room 329, Hamm Building, St. Paul, at least two weeks before the date of the examination.

Ohio: THE NURSE EXAMINING COMMITTEE OF OHIO will hold an examination for nurse registration in Columbus June 6, 7 and 8. Application should be made well in advance to the Chief Examiner, Room 110, Hartman-Ohio Building, Columbus.

conjunction with Bedford College for Women, University of London, and the College of Nursing, London, will open on August 1 next and will continue until July, 1928. The session is divided into three terms averaging ten to eleven weeks each, with two weeks' vacation at Christmas and Easter. Two months, August and September, are devoted to practical work and observation in hospitals or with public health organizations preparatory to the Courses. Further practical work in England or other European countries will be arranged if nurses so desire.

The cost of the course including tuition, books, excursion and incidental expenses and residence at the charming international club for nurses, 15 Manchester Square, established by the League with the assistance of various Red Cross Societies, comes to £250, or approximately $1,220, at the rate of exchange now ruling. This figure does. not, of course, include travel expenses to and from London.

Nurses who must be at least twentyone years of age, will be accepted in the course from societies interested in nursing, provided the request is approved by the National Red Cross Society.

Refugee Work in Bulgaria

AZEL A. GOFF, Director of Nursing at the Sofia School of Nursing, Bulgaria, gives an interesting glimpse into the work of the Red Cross missions in that country which are try

ing is also being sent through the efforts of the volunteers who do such excellent all-the-year-around work for the Production Service. The British Red Cross sent two nurses; the French Red Cross, three nurses; the Swedish Red Cross, a doctor and two nurses; and the Italian Red Cross, two nurses. These are some of the missions to which Miss Goff refers.

I have become quite international this fall (she writes) for I have entertained German, Belgian, Hungarian, French and Swedish nurses. Some Italians are in the city now whom I have met and I hear an English mission is coming. I like the Hungarians. They are both splendid, practical women. very amusing because I do not know a word of German and we have to talk Bulgarian, much to the amusement of the Bulgarians. One nurse who was here during the war knows about as much as I do.

It is

At present a Danish officer, Captain Knudtson, has been sent down here to oversee their work. They have opened soup kitchens and ambulatoria in the various districts where most refugees are gathered. The nurses are feeding and working chiefly with the children. They have no easy time and what they would have done without the money from the American Red Cross I have no idea. In many districts the mortality among the children has been fifty per cent. Most of them have only corn enough to live on to February. So that money was a Godsend, because the money from the League of Nations loan can only be used for seed, implements, etc., and will not be available until the spring.

Down in Petrich they had a fire and Sestra Eoja told me that the parents let the children burn, rather than see them starve to death.

Nursing in Albania

February 16, 1922, when she

refugees. These number 200,000, concentrated in camps. To establish them on the land, the League of Nations is guaranteeing a loan to the Bulgarian Government of nearly $11,000,000, but as this is earmarked for a specific purpose, their needs at the moment have to be met. Food kitchens are being maintained, to the funds of which the American Red Cross has contributed $35,000. Cloth

School at Tirana, Albania, operated by the American Junior Red Cross with funds drawn from its National Children's Fund, Elena Nicholas Trayan has given devoted service. She went to Albania in 1921 under the American Red Cross Commission and was transferred from Durazzo. Enrolling in the American Red Cross Nursing Service in

1921, she is a 1920 graduate of the Massachusetts General Hospital. After mentioning the fact that a woman doctor is expected from England, sent by Lady Carnavon, to take charge of the Dispensary and distribution at the Milk Station-incidentally the doctor has volunteered her services and the Albanian Red Cross is providing maintenance Miss Trayan gives a gives a most interesting idea of the work at the Dispensary:

Every morning I go to the Dispensary at 9 o'clock or 9:30. The people with whom we deal have no idea of time kept by the clock. They watch the sun and so we really start work at ten or later, finish at noon, and in summer time we have to start at seven a. m. Anybody who needs help, moral or physical, comes to the Dispensary; anybody in trouble, no matter what, comes to the Dispensary. Many of the women, still thinking it is American, believe they will find comfort of some kind. We try not to disappoint them. Here in Albania are no charity organizations or employment bureaus or anything of that kind. As we are naturally social animals, we need the help of our fellow members, so it is not strange or unnatural that they come and we are only too glad to do what we can and help in any way we can. It is almost five years since I came to this work.

Our Dispensary is more or less general and I come across all kinds of things; for example, a mother brings a child who has a burned arm. The baby fell in the fire while the mother was washing the laundry. If the doctor is not in, and no one knows when he will come, I am allowed to treat the hand and ask the mother to come again to see the doctor and have the dressing changed. This is a good thing because of the psychology of the people. It is better to give a spoonful of castor oil to the child than have the mother go back, probably walking two hours each way, without any kind of treatment. When we do something for the child-when the doctor is not in-and it does not matter how small it is, the mother is given courage and will try to come back. It is fortunate that the doctor allows me to use my judgment, for if she is told, "No doctor today, come tomorrow," she will never come back. If a baby needs a bath, I go ahead and give it, teach the mother how to do it, dress the baby

with new clothes (American layettes) and the doctor has a clean, nice baby to examine.

For the last six weeks I have been alone in the Dispensary with an old woman to help me with the cleaning up, water, etc., and the doctor comes, when called, to examine patients. . . It will be wonderful when the woman doctor comes. I have so many places to take her to-women who will rather die than see a doctor or when the husbands do not allow their wives to see a man doctor!

The milk is distributed every morning. Three times a week there is a consultation for the babies and a French teacher and her pupils are present, learning methods. I do not know what method she uses but I do know that her girls speak French quite well. It is good to see their interest.

E

Item

LISE B. MOSER, who has been Directress of Nurses at the Haitian General Hospital since June 20, 1924, writes Miss Noyes (who is back at her desk nearly her old self after a trying month's illness) that the Christmas party for graduates and student nurses was a success. Comfort bags sent down from Washington gave a great deal of pleasure. "One of the nurses," says Miss Moser, "was too sick to attend and when I went to see her after the party, I found her going through her bag with a beaming face." Nine probationers had just been capped, two of whom were French nuns. Another was beginning her three years' course in midwifery. These are the first nuns to take nurses' training in Haiti. Nine probationers were accepted on December 31 at the end of the fall probationary period; and for the spring class, seven were enrolled, all that could be accommodated in the available dormitory.

11. What preparation should a nurse have for county work and how should she set about obtaining it?

Answer-Any nurse who wishes to do any type of public health nursing needs some special preparation. Nurses are trained to care for the sick but in most hospitals, even at the present time, little if any training is given in the prevention of disease or in any of the means of health promotion.

The best start in public health nursing is through staff work under supervision and instruction of experts. This enables the nurse to become familiar with the details of contacts in the home, personal and family health work, recognition of social problems, coöperation with other agencies, conferences and group teaching, and the like. Often a course in the principles of public health nursing can be taken at the same time, if a University giving such a course is near. In rural sections, the nurse usually is not only responsible for all phases of health work but she is frequently the only person able to mobilize the community resources and it is often necessary for her to assume a sort of community leadership.

Because of this, the usual requirement for county nursing is one year's experience on the staff of a well organized public health nursing association which has a definite program for staff education and four months (preferably one school year) in an accredited course in public health nursing.

Further information, as well as lists of accredited courses and of available scholarships, can be secured free from the National Organization for Public Health Nursing, 370 Seventh Avenue, New York.

12. What is the accepted practice in giving morning care to patients and, in particular, at what hour is it started?

Answer.-Morning care really involves two procedures, one performed before and one after breakfast. The following outline is fairly typical:

A. Before breakfast:

1. Bedpan is passed.

2. Mouth cleansed.

3. Face and hands washed.

4. Pillows shaken and top covers straightened.

5. Back rest, where used, is adjusted. 6. Bedside cabinet arranged for breakfast tray.

After breakfast:

1. Bath, back rub, care of nails. 2. Clean gown, bed made, linen changed as necessary.

3. Hair combed.

4. Leave clean face towel and wash-
cloth in drawer in bedside cabinet.
5. See that cabinet contains the re-
quired articles and is in order.

6. Supply pitcher of fresh water and a
clean glass.

7. Supply some mental occupation.
8. Adjust signal cord and leave within
reach.

9. Record and report any significant
symptoms noted.

B. All patients in rooms and those who are

acutely sick in wards receive a daily bath. The ward patient whose convalescence is well established is bathed every other day. This is the only difference in the care we give our room and ward patients. The real problem underlying this question is one of the most difficult administrative problems that confronts the director of a nursing service. It involves the comfort of the patient, especially the patient who dislikes being awakened early. On the other hand, unless the hospital has a very large corps of nurses, and if medical rounds begin late, it is a practical impossibility to avoid a conflict of medical and nursing care, if morning care begins late. One hospital requires its wards to be settled by 8 p. m. and morning care begins at 5:30, thus assuring patients ten and one-half hours of quiet. Since the house staff at this institution begins rounds at 7:30, the nursing service is obviously doing its very best under the circumstances.

Two-thirds of the hospitals answering our question begin this care, in the wards, at 5:30 or 6. Several are even more specific and state "not before 5:30." The other answers vary. It is obvious that visiting hours influence them. A definite effort to delay awaking patients is indicated by all. One, only, states that morning care begins at 7 and private patients are not wakened. It is to be noted, however, that this hospital has an unusually large number of special duty nurses.