There’s no shortage of ‘upstream thinking’ nurse practitioners

Within the field of nursing, an important “upstream thinker” was Lillian Wald, founder of the Henry Street Nurses’ Settlement in New York City in 1893. Wald coined the term “public health nurse.”

 

Writing about Wald’s contributions to nursing, Dr. Elizabeth Fee, chief medical historian at the U.S. National Library of Medicine in Bethesda, Md., and Dr. Liping Bu, a history professor at Alma (Mich.) College, said: 

“Wald believed that public health nurses must treat social and economic problems, not simply take care of sick people. The public health nurse should be involved with the health of an entire neighborhood and cooperate with social agencies to help improve living conditions.” 

In 1893, nurses Wald and Mary Brewster moved to New York’s Lower East Side to begin caring for poor people in the tenement. Within the Henry Street Nurses’ Settlement, they gathered six more nurses and social reformers.

 

In addition to providing nursing care, they took neighborhood members on picnics, on excursions to the country and to music concerts. They formed girls’ clubs and offered cooking classes. The yard behind the house was converted into a large playground.

 

Next came the Henry Street Visiting Nurse Service, with nurses visiting homes of all nationalities across the city. In 1917, the Nursing Service gave 32,753 patients bedside care and attended 21,000 sick children in their homes. Wald and her team kept moving farther and farther upstream.

 

The visiting nurses unit eventually had a staff of about 100 blue-uniformed nurses who went from tenement to tenement, offering free or low-cost check-ups and treatment, mostly for immigrant mothers and their children. Rather than climbing all those tenement stairs on their rounds, the nurses simply hopped from rooftop to rooftop, like this nurse is doing here.

In a sense, Dr. Deborah Lindell, a nursing professor at Case Western Reserve University in Cleveland, Ohio (shown below), believes that Wald took that baton from Florence Nightingale, a nurse of British heritage, who lived from 1820-1910, and is remembered as a social reformer and the “founder of modern nursing.”

 

“Wald, as Nightingale before her, understood from providing care to those members of society who were impoverished, disenfranchised and otherwise vulnerable, that many of the health issues they faced could be prevented by upstream actions focused on changing/enacting public policies,” Dr. Lindell wrote.

 

Historians acknowledge that Nightingale’s most famous contribution to nursing came during the Crimean War (1853-56), when she sounded the alarm about the “horrific conditions for the wounded at the military hospital on the Asiatic side of the Bosphorus Strait, opposite Constantinople, at Scutari” (now within Istanbul, Turkey).

As background, after Britain and France entered the war against Russia on the side of the Ottoman Empire, Nightingale’s staff of 38 female volunteer nurses and 15 Catholic nuns were mobilized and sent into the war zone in October 1854.

When they arrived, they found the living conditions at the field hospital to be deplorable…and killing the patients. In fact, 10 times more soldiers died from poor nutrition and illnesses such as typhus, typhoid, cholera and dysentery than from battle wounds.

 

Overcrowding, defective sewers and lack of ventilation at Scutari were corrected by the British government’s Sanitary Commission in March 1855, almost six months after Nightingale had arrived.

During the Crimean War, Nightingale gained the nickname of “The Lady with the Lamp.” The Times of London reported on Nightingale’s presence:

“She is a ‘ministering angel’ without any exaggeration in these hospitals, and as (she) glides quietly along each corridor, every poor fellow’s face softens with gratitude at the sight of her. When all the medical officers have retired for the night…she may be observed alone, with a little lamp in her hand, making her solitary rounds.”

 

The phrase was further popularized by Henry Wadsworth Longfellow in a poem written in 1857:

 Lo! in that house of misery

A lady with a lamp I see

Pass through the glimmering gloom,

And flit from room to room.