History of Nursing in Pacific Canada

[1948 Diary Hamilton Ontario] Creelman, Lyle, 1908-2007 1948

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   DIARY
HAMILTON, Ontario
 HAMILTON
March 11. 19A8
Meeting of medical sub-committee in Hamilton, tir, Mosley, Dr* Puffer,
Dr. Hitching and Dr. Baillie sat in on first part and then came out to discuss
survey with Mrs. Haygarth. There was a great deal of resistance on her part*
This is a bad time: - (1) x-ray survey - on discussion find that the only extra
work for the nurses is the following up of cases and contacts found. (2) measles
epidemic - apparently nurses have to visit every case, chiefly for purpose of
filling out epidemiological card* Eointed out that survey might help in this*
Finally, Mrs. Haygarth suggested that she gather the nurses in on Saturday morning
and I could speak to them.
March 13. 1948
Came to Hamilton so speak to nursing group of which the majority assembled
in the Health Centre. Mrs. Haygarth's reception a bit better - some of the nurses
had been coming in for reading material - they nwere jittery about this". Don't
know what explanation was given on Friday*
March 15. 1948
Monday - returned to start survey. Interview 11-12 noon with Mrs. Haygarth.
Very difficult to keep her to the point. Will take a long time and many interviews
to get the required information. She seems to take on too much of the administrative
detail herself - question amount delegated to her supervisors - especially in Health
Centre.
Lunch with Dr. and Mrs. Kit ching.
1.30 p.m. went with Miss Dean (F.H.N.) to Immunization Clinic at Central
School. Two other nurses, Miss Hilbert (in charge) and Miss Nugent. Also student
from St. Joseph's. Dr. Laura Martin came to give immunisation. Elaborate set-up
prepared. Syringes and needles boiled and placed between two sterile towels*
Immunisation vials soaking in alcohol. Table outside door where two nurses worked.
One nurse (Miss Hilbert) went to class rooms to collect children. Second nurse
checked names on list and notified Doctor when special tests such as protein or
Schick. Third nurse cleaned arms, (wore mask for this!) Technique used -
1. Wash with green soap (great abs. swabs)
2. Wash with alcohol (great abs. swabs)
3* Swab with iodine.
With all this elaborate preparation - mask, etc*, the child was not told to hold
his sleeve up and frequently it dropped down and the arm contaminated*
The student asked what she could do. Was told, "Oh, you can help the doctor".
This was not really necessary. Could much better have been employed to clean
arms and thus relieve an extra nurse. Student not given any explanation of
immunization program. No teachers or volunteers used. Definitely a waste of the
time of at least one nurse. Left at 3 and clinic not yet completed.
 -2-
March 15. 19A8
3.00 p.m. Returned to elinics at Health Centre.
Chest Clinic - Miss Moffatt, nurse in charge.
Dr. Holbrook, doctor in charge.
One other nurse taking histories.
Student taking names, weight, temperature, pulse. Student had
little opportunity to see more and would be there again.
Two other doctors - from San?
A large clinic as many were coming in from Provincial survey. Three beds
obtained immediately from Sanitorium for three cases. Excellent relationships and
co-operation there. (Dr. Holbrook recently retired as Ch& at Mountain Sanatorium
and works part time in Health Department Chest Clinic).
Did not get much on follow-up by nurses. Obtain this later.
Baby Clinic
Nurses had interviewed all mothers (28). Volunteer had weighed.
Two nurses * Miss Smith, Mrs. Dingwall
Dr. Carr, Pediattician, arrived late.
Observed Dr. Carr. Mother would sit down - he read nurse's notes and
questioned on feeding. Made suggestions re diet frequently* Initiated notes and
mother left. About 1 minute] New babies were placed on table by nurse and examined
very, very briefly. Nurse was frequently lax here in not bringing mother into the
picture as much as possible. Too much banter between nurse and Doctor in front of
mothers. After all cases seen by Doctor, immunization was given. Bo masks here*
Why difference?
March 16. 1948. (Tuesday)
9.00 a.m. At Mcllwraith school with Miss Harley. This school is in rather a poor
district. Children all have rather low I.Q. Pediculosis cases quite numerous. A
difficult group to teach and therefore all the more need for demonstration and
illustrative material. Met Mr. Lowden, principal.
Routine of school work seems to be:
1. Test children for vision, weigh and measure.
2. Test hearing.
3. Referal of kindergarten and Grade I pupils not examined in summer
to doctor*
4* Doctor examines Grade 8 and if possible Grade 5.
5. Referals from nurses' screening to doctor.
6. All corrections, except dental, must be referred to doctor to mark
correction on card.
Miss Harley referred to what she was doing as the "Thorough Class Room Inspection"*
Teachers do not weigh or measure or test eyes.
Nurse does not give class room talks*
Seemed to be rather a lot of clinical work. Several lists, forms for immunization,
 -3-
consents, etc. No clinical assistance in this school for teachers.
Re Sanitation - nurse seems to take little responsibility. Apparently the doctor
and nurse make one inspection yearly. Remainder of the time, the nurse accepts
any complaints.
Re Communicable disease • Special class room checking for scarlet fever and
other serious diseases.
(See write up of school visit No. 1)
Lunch with Dr. and Mrs. Hitching.
2.00 p.m. - Met Miss Fawcett who is on the staff of Health Dept. but is in
charge of V.D. and Pediatric clinics at hospital. Appointment arranged with
her Monday, March 22 at 1.30 p.m.
2.15 P.m. - Visited Baby Clinic at Health Centre. Same two nurses as yesterday*
Mrs. Dingwall not usually at this session but regular nurse ill. Not as large
an attendance. Seemed considerable waste of time. Miss Smith could have been
doing records after preparing her part of the clinic.
Sat with Mrs. Dingwall during her interview with three mothers - two new babies*
Took information for front of history form. Asked routine questions re formula,
extra feedings, C.L.O. etc., and sleep. Re-appointment made. Asked one re
vaccination and arranged to give to-day. Others not old enough for immunization*
Ho literature given or referred to. Nurses have only regularly printed literature.
Box on desk contains forms only.
(See write up of Clinic visit No.l)
3.30 p.m. • Interview with Miss Helene Sneddon, Superintendent V.O.N. Very
charming and very friendly reception. No question but what nurses would do
job analysis - would be very useful for them. Asked me to explain the survey
to the group next Monday, 8.30 a.m.
Met Miss Lawson, Assistant Superintendent and the Nutritionist. Arranged to
interview them also. Will arrange visits to V.O.N, after Easter in order to
try to complete Health Department before*
 Wednesday. March 17. 1948.
9.00 a.m-
Interview with Miss Wright, Supervisor at Health Centre. Miss Wright
was with the Board of Education before amalgamation. Her major experience has
been in the school service and one has a feeling that this aspect is still her
major interest. In discussing her duties it was hard -Mb pin her down to a definite
subject. In regard to the introduction of the new nurse - she feels that they
need a great deal of guidance. Wants to be with them most of the time in the
schools for two or three months. Demonstrates all visits, Including birth registration. One feels that not a great deal would be left to the initiative of the nurse -
■ore a case of telling her what to do than guiding. Would not go with more senior
nurse unless specifically asked and then it would be to solve some problem. Not
a real supervisory visit. No planned educational program. Is overwhelmed with
detail work, filing, etc., and cannot see the bigger issues over these. No time
to go to committees and do what the health department wants her to do. Does not
talk the language of modern supervisor.
Although monthly reports come from the main office giving statistics,
relative to to time spent in services, no attempt made to use this as guide. No
idea of time percentages. Had figures of pre-kindergarten examinations but bad
not worked out percentage of total entering school*
Although Miss Wright is available for nurses to discuss cases with her,
from observation this seems to be done by going from desk to desk and telling
nurse about new records which have come in. No planned individual or group
conferences.
Would think that in this centre nurses would be rather confused as
Mrs. Hagarth also goes over work with them.
When asked about weaknesses in training, Miss Wright first mentioned
records. When questioned specifically, this breaks down to local records* Feels
they should be better prepared to recognize all problems when they go into a home.
Also need more basic training in mental health.
Miss Wright has a pleasing personality and is no doubt efficient in details
but modern methods and meaning of supervision do not seem to be comprehended. How
important the supervisor is in a health program • it is probably in administration
and supervision where we need to put more stress in preparation*
Wednesday. March 18. 1948. p.m. Back to Toronto
Thursday. March lfr 1948
11.00 a.m.
Interview with Miss Boyd at Queen Mary Centre. Mrs. Hogarth is really
trying. Took me out to the Centre - had the car washed because I would have been
ashamed to ride In it before m but did not go in with me. Had phoned Miss Boyd
to be at the door so she would not have to take me down through the basementl
Miss Boyd served in both world wars. Was in charge at Borden In the
last and later in charge on the "Letitia". Her experience has given her a breadth
of interest and understanding which reflects in her supervisory program.. One has
a feeling that the nurses are allowed more initiative and are permitted to take
 -5-
responsibility just as soon as they are able. Her supervision is given according
to need and there is more guidance in it than with the others* Is available at
all times for the nurses and when conference is indicated brings them to her desk
to sit and discuss. Has regular Saturday morning conferences. Has developed
several administrative aides (carry over from the army,  she says) which help, e.g*
index tafta* in record box. Miss Boyd also lays great stress on the immunization
set-up and clings a little to the old custom*
Miss Boyd was the only representative from Hamilton at the refresher
course which was recently held at the School of Nursing. She got a great deal from
the lectures. She can see the larger issues and is not bogged down with detail*
In this supervisor we see the influence of a broader experience - not
necessarily a course In supervision - as a good background for supervision in
contrast to growing up with the agency and not having experience elsewhere* Personality no doubt figures to some extent also.
Thursday evening - With Mrs Hogarth attended the annual joint dinner meeting of
the Hamilton Community Chest and Council of Social Agencies. Held in Winston Hall
which was used during the war to house some 300 war workers and has now been taken
over by the I.W.C.A. Very attractive large lounge. Excellent dinner. Reports
mimeographed into booklet and available for all. Synopsis of each brief and to the
point. Chancellor Gilmore of McMaster an excellent chairman. Panel discussion on
how money raised, very good. Over 200 at dinner. One had a feeling that the
citizens of Hamilton are keenly interested in their health and social agencies.
This was a large attendance, especially since this meeting was apparently the last
of a long series of annual dinner meetings.
Friday. March 20. 1948. - Went to office before going to school for observation.
Cold very bad and rain terrible so cancelled appointments and returned to Wentworth
Arms, (much nicer than Connaught) Worked all morning and returned to Toronto on
2.15 train.
 HAMILTON
Monday. March 22. 1948t
8.30 a.m. Conference with V.O.N, nurse re survey*
9.30 a.m.
Hamilton Branch Canadian Red Cross.
Miss Buchbee, nurse-in-charge.
Conference with Miss Stevens. Director of Visiting Homemaker Service*
Have 17 Homemakers. All go to Toronto for a two weeks course sometime during their
first year. 8 of the 17 are on full time and the remainder on part time. Do not
have enough to fill calls.
Accept only short term cases - chiefly where the mother is ill. They are now considering whether or not they will extend their service to old people. Get many calls where
all that is needed is perhaps one day a week - do some cooking, tidying up and shopping.
Enough to keep the old people out of the Old Folks' Home*
Apparently the Family Welfare have a group of their own as well as V.O.N. Can also
obtain Home Aides through Employment Service. According to last annual report of
all the filled calls, 380 were made directly by client (sometimes told to do so by
agency) and only 20 from other sources* This does not indicate very extensive use
by agencies, Including Health Department.
Conference with Mrs. Cambridge. Nutritionist*
A real live wire* Was with British Ministry of Food in England. (Replaced Jean
Ritchie, who, she said, was fired!) Last year was part time with the Health Dept*,
but that has been discontinued since January 1948. When asked why, she said the
services were not appreciated. Apparently there was some trouble with the Volunteer
Home Economists who were available for counselling in Baby Clinics. Would be shoved
off into a corner, - no effort made by nurse to refer cases, etc* This seems clearly
a case of the Supervisors and Director not appreciating the service and not guiding
the nurses in the use of a consultant service. There may be another side to the
question but can't help but feel that the nursing department is most at fault.
Mrs. Cambridge also told me of the course of lectures she prepared and tried te
present to the nurses. One on budgeting - did'nt go over although she tried to make
it practical. Said you realize you are not appreciated when a professional group
yawn and look at their watches*  So the next week she thought she would be technical*
One nurse came up afterwards and said "I've been nursing for 26 years and I have not
opened a text-book since I finished training. You don't need that information to
tell the women in the north end about nutritionl"
Another nurse said "I hate nutritionl"
What is at the root of the public health nurses aversion to nutrition?
Mrs. Cambridge has many activities going now - are education for the
co»mity but instead of credit going to the Health Department it gDes to the
Bad Cross.
 11.00 a.m.
Interview with Mrs. Gallowayf President of the Hamilton Industrial Nurses I Association,
at the American Can.
Can get information through them re nurse in industry. As next meeting of the group
is on April 5th*, invited nyself to it to tell them about the survey and get them
to do job analysis. Very co-operative
2.00 p.m.
Conference with Miss Fawcett at Special Treatment Clinic, O.P.D. of Hamilton General
Hospital. Miss Fawcett is on staff of Health Department* She is called the "social
service" nurse, at this clinic. The hospital staff of the treatment clinic, Miss
Fawcett interviews patients and is responsible for follow-up. The district public
health nurse does not do any follow-up. There is an untrained man who sits in the
main office of the Health Dept. He is also apparently supposed to do "follow-up"
but this consists mainly of writing letters* (Later learned he is responsible for the
'legal aspects')*
Miss Fawcett says the number of delinquents is increasing,
to check. Clinics are as follows:-
She has'nt sufficient time
Mon. 4 - 6.30
M.
G.C.
& S.
Tues. 8.45-9*30
M& F.
a
jf
Wed* A.M.
Children
V.D.
& Pediatrics
Thurs. 4 - 6.30
M& F.
G.C.
& S.
Fri* 4 - 6.30
M
G.C.
She is at all these clinics and has the records to do in addition. Has a record clefrk
as assistant. There is also a Junior League volunteer in each clinic who pulls the
records as the patient reports* (Later Mrs. H. denied that any volunteer in V.D.clinic)
Miss Fawcett refers to the social history. Saw several records. All that is written
in this section is the date and circumstance of contact. Nothing approximating social
work done. However, Miss F. probably carries a lot in her head but this would never
be known to successor. Miss Fawcett says she has been there 10 years and had no
supervision of any kind. Would welcome it. Would also like to go away to take course
and see what is done elsewhere. Told that this is not necessary* Miss Fawcett seems
to be doing her best but would say she is somewhat limited. Would think she would
appreciate some guidance. Both she and Miss Inrig, the nurse-in-charge of O.P.D* spoke
very highly of Dr. Leroux and appreciated the improvement he made*
Number of cases for February only 386. The greatest number was 506 - December 1946*
These figures seem low for an industrial city the size of Hamilton. Also several of
these are from district outside the city*
Later was told that all cases are not reported to Health Office • are reported directly
to provincial government. So attendance at clinic is not an indication of total
numbers.
In an interview later with Mrs. H. she said the nurses carry the delinquent V.D. cases
when in families. Could not get this confirmed in actual practice*
 -8-
Tuesday. March 23. 1948.
9.00 a.m.
Went to George R. Allen school in Westdale to observe nurse and doctor.
Miss Reid, who took her public health certificate at McGill and Dr. Glass, a local
general practitioner. Miss Reid very quiet, nice manner with children« Dr0 Glas*
young and interested in the work. Felt that too many referred needlessly to the
Doctor (See School visit No. 2) Also a lot of doctors time wasted. Children not
always ready for the doctor. A very nice medical room opposite the main office -
but not one poster*
1.30 p.m.
Saw Mrs, Haygarth in her office while waiting for nurse to go visiting.
One remark made rather indicative of whole attitude. I asked her in which provincial
supervisor's territory was Hamilton. "Miss Pentrpa*^ but she rarely comes. Miss
Nicolle come*more. She is the Educational Director. But we don't need help - there
are plenty of places to go in Ontario where they have'nt trained workers"*
Mrs. Haygarth complained agdinabout the nursing statistics being done in main office*
All these things possible of modification but she lacks the personality to bring them
about. Criticized the development of the V.O.N, into the health education field and
when asked specifically does not know what Miss Sneddon means by their health education visits.
2.00 p.m.
Out with Miss Morrow, (See Home Visit No. 1). Miss Morrow was in the any
and after returning took her public health at Toronto. Is in her late thirties or
early forties. Went first to Day Nursery. Really a wasted visit, Then on home
visits, all but one of which was for measles and in none of which was any teaching
done. Would consider it almost a totally wasted afternoon. It seems that for all
cases of communicable disease the family doctor visits, an inspector from the Health
Department visits and the nurse visits!  What an utter waste of time especially if
the afternoon's visits are typical. Epidemiolpgical card is filled out. Just recently
the amount of information to be recorded has been reduced*
Wednesday. Mhreh 24. 1948.
Spent morning at Health Centre with Mrs. Haygarth trying to complete
interview guide. Think this is not a good way to do this. At next place give separate
outline for statistical information only. Remainder of outline to be completed as a
result of conference and observation and not gone over with Director. There is some
discrepancy between what is said to be done and the actual practise observed. It is
the latter which is the most important for the survey. Also it seems to me that the
most valuable method of obtaining the information required is by getting out with
the nurses,
Mrs. Haygarth so easily put on the defensive.
2.00 p.m.
Went to Queen Mary Centre to go out with nurse. Miss Boyd took me to each
nurse at her desk and introduced me. She had a nice word to say with each. How
different from the Health Centre!
 -9-
Went home visiting with Miss MacKenzie who had the city car. A very
pleasant nurse - has not had public health - graduated from Toronto General and
following that took a P.G. in Pediatrics in Detroit. Was a supervisor in the
Pediatric Dept. for two years. Came home when her father died - 20 years ago -
and has been with the Health Department ever since. Always wanted to take the
course but never got away for it - always wanted to go other places but never did'.
Would have benefited by course - can see how others have - and would be able to
do a much better job even without if there were a staff education program. Following
the visits I could not see where any health teaching had been done. The majority
were CD., and what is the sense of trying to talk isolation for measles to a mother
(low I.Q, often) with three children in three rooms? Nurse did not try anyway.
Our general health education should teach the method of avoiding complications but
of what value is much else? Nearly all the mothers in those two visits had had the
family doctor - even when the second child developed the disease,
(See Home visit No. 2)
5.15 p.m. Back to Toronto
 -10-
"HAmfON
Monday. March 29. 1948
Official call at R.N.A.O. office. Talked with Miss Fitzgerald and Miss Walker re study.
Lunch with Miss Walker,
Tuesday. March 30. 1948
Hamilton V.O.N. Conference in morning with Miss Lawson, Assistant to
Miss Sneddon. Miss L. responsible for the introduction of the new nurse, student
program and staff education program. Has a very well planned introductory program.
Has a keen appreciation of modern educational principles - changes with the times •
stresses the teaching, techniques are secondary. Gives real supervisory visits and
follows these with a written report which is discussed with the nurse.
In discussing student program remark was made that students frequently say
in relation to the V.O.N, experience - nD, this i so much more interesting than public
health'" Have only two days with the V.O.N. Have two weeks with the Health Dept. which
is too long for observation.
P.M.  Home visiting with Miss Truesdale. Miss T. has been with the V.O.N, in Hamilton
for over twenty years. Has had public health. Her techniques were always good - her
manner friendly and interested (See report of Home Visit No. 3.)
Attended V.O.N, staff Hard Times party. Very friendly spirit among the group. Have a
staff committee who are responsible for such things as well as for making suggestions
regarding staff education program.
Wednesday. March 31. 1948.
A M with Miss Sheppard of the V.O.N. (See report of Home Visit Nb.4).
Miss Sheppaid has been unable, because of family ties, to take the public health course.
ESdUkTto have done so. is interested in her work and very ^^^•^
into one home that had been in last week with Health Dept. nurse. (See Home Visit
No. 2, Visit 10). Overlapping seems obvious,
P.M. H6me visiting with Miss Joliffe, Miss J. had her public J»*tt *»«»•-
1945-46. She is a bit "off-handed" and perhaps not quite as dire^ about ^r teaching
as she kght be. Her technique might be questioned. For example, all the J*^™-1*
Zrsel observed found a newspaper before putting bag down. Miss J. put it down on
ESfor co^A and got pape/afterwards. Also she used the same apron in a visit to a
pre^tSe £oy (8Meksfthat she had worn when taking the temperature of a measles
case in the previous visit.
As we were late in starting and had to return to the office early only two
along. Also she ielt tha**»J2££« J^u, jJJ, M been i». Iajeeted blood inf
££ *ZZrltZltMdHET!JS». -*Shed, took temperature. Decreased for»ula,
 -11-
temperature of 2£- year old orally. During course of conversation it was stated by
the mother - "The man from the Health Dept. was in about quarantine and that he
bawled me out because I had'nt reported the measles" (Doctor had already reported
the older child). Mother was quite indignant about this*
Next visit was to a baby, now eight weeks old, which had been born prematurely* Mother of Italian birth, very nervous about her child, clean, well furnished home.
Nurse weighed baby and discussed general care. Mother asked questions. Mother sat
rocking the basket in which the baby was lying. Nurse did not make any mention of
this although I am sure this Mother would have readily accepted and explanation of
why this was not good for the baby.
Thursday. April 1. 1948
A.M. with Miss Lelen at Moodie's Textile factory. Arrived shortly after
10.00 a.m.
This is one of the seven industries which buys nursing service from the
V.O.N. The nurse spends four hours a day, five days a week. This factory provides
the most ideal working conditions for the nurse of any of the others and is also the
largest served.
There ere 420 employees of which approximately 00%  are female.
There is no part or full-time medical service. Two doctors may be called
as consultants - it is mostly compensation cases which are referred.
There is no pre-employment physical. The nurse sees all new employees within
two or three days after starting. There are standing orders covering first aid*
During the morning the nurse saw about seven cases. Chiefly minor first add,
menstral .pain and follow-up from previous accident. In talking with all of them nurse
brought in general health habits. She seemed to knwo her cases very well.
It was noted that she did not use her records. There are individual records
for each case. In addition she completes a day sheet for the purpose of compiling her
monthly report. This sheet has the name of the employee seen, the reasons for seeing
and treatment given and certain other checked information for statistics, I feel that
writing the name and reason for seeing etc., is needless. This should be written
directly on the record. This nurse apparently just copies this information onto her
record and is therefore, not using the record to the best advantage. (Discussed this
later with Miss Sneddon, who insisted this list was necessary and the records were always ,
used when interviewing cases, except when a number of first aid cases at one time.)
These individual records had little or no social data. There was really very little
for a new nurse if there were a change.
Her monthly routine reports to management were very good. Is concentrating
on the need for part time medical services and uses illustrations from actual cases.
Prefers to follow up in home herself even though not in her own district.
This concludes the observations visits with the V.O.N. To prove there is   * 1|
overlapping following is a summary of home visits madd*with the V.O.N.s
 -12-
1. Infant welfare - 3 months old (P.H.N, of H.D. had been in)
2. "      "    - 8 wks.  "     "   «•  « n        n      n
3. Prenatal
4. Child Welfare - 3& year old girl had been ill six months previously when nurse
visiting for pre-natal case. Did not check if H.D. in*
5. Medical - Insulin
6. Surgical -, Breast abscess
7. Infant welfare - 4 wks. old (Called previous week with P.H.N, of H.D.)
8. General care - arthritis
9. Infant welfare - 3 months old (P.H.N, of H.D. in re measles case)
10.    "    "    - 8 weeks old, but born prematurely. Did not check re H.D.
Six infant and child welfare visits - none of these the regular (policy) 6 months
visit and only two under six weeks.
In no case do I recall was referral made to Health Department nurse, and certainly it
should be done for some of these cases.
P.M. Observation in pre-natal clinic at Health Centre (Health Dept.)
(See Clinic Visit No. 2)
Miss Harley, the nurse in charge, assisted by one other public health nurse
and two volunteers from the Women's Auxiliary. There was also a student from the
General Hospital. Would not let student weigh before volunteer came because - Mrs,——
very fussy". Only sign outside waiting romm was "Chest Clinic", A great deal of
rushing on the part of the nurses to get the interviewing done before the doctor came.
Lack of privacy. Doors were not closed for interview with nurss. Iijroom where new
admittances were being interviewed door was open into office where chest clinic nurse
and stenographer were working. Later the doctor interviewed his cases, which were not
being examined, in the same room under same conditions but with one nurse and sometimes
two, hovering over him. Very difficult for any patient to feel that she was the
centre of attention. Although there is a space on the pre-natal record for "social
data"' on none of the three cases newly admitted was any social data recorded. Instead
HA this space an entry was made about whether or not the mother would make her own
arrangements about confinement and whether or not she needed a layette given to her.
And one of the cases obviously had a problem - it was very noticeable that she (18 yrs.
old and her second baby) was worried because her husband was out of work and did'nt
seem to keep any work. This was just brushed aside with "Don't worry!" Cases who
had been at clinic previously for this pregnancy were interviewed by the second nurse
who had a much better approach. However, she did not touch on social prbblems either.
Her questions were confined to the physical. One had a feeling also that the mothers
must have felt that the chief purpose of the interview was to get the record completed.
Work slip for the district nurse was filled in during the questioning, although it
would have been much better to do it after the mother left. This nurse took the B.P.
even on the newly admitted cases who were first seen by Miss Harley. And in these
latter cases there was some repetition in the interview. It apparently was not
clearly defined what each should cover.
 -13-
Miss Harley was heard frequently admonishing certain mothers not to wear
round garters. One would think from her tone that it was an unpardonable sin!
When the doctor came (late) there was a great rush to get the mothers who
were not being examined to see him. Even almost had them line up at the door. His
interviews in some cases, gave no more information than the nurses and it had been a
long wait for some of them.
Observed the doctors examination of one woman. He called out his findings
while Miss Harley recorded. Must have been rather upsetting to the woman to hear
"plus 1", "only fair", "considerable discharge", etc., called out in relation to certain
record items. One felt that the doctor would not use this approach with his private
patients. His first contact with the woman to be examined was when she was on the
ayp^ning table. After the examination he would see her again. This interview was
not observed.
• This clinic averages 12-17. They return every two weeks to the 34th week and
then every week. A specimen of urine is brought which is examined by the laboratory.
In relation to the size of the city, the total number of pre-natals seen  at this
clinic and the hospital clinic seems small*
One of the W.A. volunteers weighs the patients and charts the weight. She
also writes the name and weight in a book. (The nurse taking B.P. also writes name
and B.P. in another book. These books are "just to have it". No satisfactory explanation of their use. The other volunteer sees the women referred for layettes, etc. &ne
sits right in the waiting room and there would be no secret about anyone who wanted
h&p!
 -15-
Tuesday. April 6. 1948.
AJk Observed post-vacation inspection at Armstrong School. Miss Tyson, the P.H.N.
Took her P.H. in Toronto during 1945-46.
Saw first inspection in Kindergarten class. 56 children. Nurse sitting.
Children in circle (very close together) and filed past nurse. Had them show hands,
looked in throat, and for each child took two tongue depressors and examined hair.
Discarded depressors. This seems rather extravagant as the technique consisted of -
(a) proximity of children in line
(b) the fact that clothes in clothes hangers are very close and frequently one on
top of the other.
(c) technique used by doctors*
Asked Miss T. if this was the technique as set down in policy for Hamilton.
Said she had taken her field work in Kirkland Lake, (Miss Pinchbeck there then) and
she thought it good. When she came to Hamilton they more or less left her on her own.
Judge by this and other observations that -
(a) Miss Wright does not give as close supervision of the new nurse and she would
imply
(b) there is not policy manual with techniques to be observed.
Next class inspected was Grade 8* Each row lined up and same procedure gone
through. Although nurse stood by the window, children-did not approach so that best
advantage was taken of light*
P.M. Home visiting with Miss Tyson, (See report Home Visit No.5). A very alert nurse -
she likes her work and is very conscientious. Tries to keep it right up-to-date. Says
she makes about 40 birth registration visits per month* Says policy is to make a
visit then, at six months and a discharge visit at a year* Said she got all her
measles cases visited - thought it rather foolish - just a case of dashing in, filling
out card and dashing out again, "But then, my opinion is never asked." Asked her
about unions - said did not have to belong and that she had never been approached*
She thought that in the Health Dept. only some of the older nurses who belonged.
Asked about needs ln training, suggested that both psychology and nurtrition should be
compulsory and not electives. Feels a need for good staff education program. Tries
to make the work interesting fof the student.
In the evening at Miss Sneddon's for bridge. Miss Sharps, Miss Allison,
Miss Haverson, Miss Young, Educational Supervisor at Hamilton General, Miss Blackwood,
Pediatrics Supervisor at Hamilton General and Miss McLean. Miss Young is going to
Kitchener as Director of Nursing.
Wednesday. April 7. 1948.
A.M. With Miss Lawson at V.O.N, discussing methods of supervision of nurse.
P.M. Conference with Miss Nash.
 -16-
Friday. April 9. 1948
Interview with Dr. Albert Rose, Research Director, Community Chest of
Greater Toronto. Had been informed that Community Chest had made a job analysis
of agencies, including V.O.N. This analysis was done for the purposes of salary
setting, as have most of the analyses on which information is obtainable. Questions
asked re age, qualifications etc., and asked to write a description of their job.
Were also asked to estimate time spent on the various phases of their activities.
The examination of these job descriptions is made by reading them over and noting
frequency with which certain items occur. Actually no information is obtained which
could not be compiles by two or three people on the executive or supervisory level.
The time estimation was not used and probably useless. If time is needed have to do
a separate study. This interview more or less confirmed my own feelings in respect
to job analysis.
Monday. April 12. 1948 - Hamilton
Spent the day - U a.m. to 3.30 p.m. with Miss Fenton at Mountain Sanatorium.
She is the senior of two public health nurses on the medical services staff. The
institution has over 700 patients. 100 graduate nurses. 40 nursing assistant*# The
two public health nurses do the only social work. Have no clerical assistance. They
admit all new patients. Try to give them a friendly introduction. All new patients
admitted to one ward. Miss Watson tries to follow up the teaching while they are
still on this ward. Was told relationships with Toronto Health Department are much
better than with Hamilton. Miss Larkin, P.H.N., T.B. Supervisor for Toronto spends
about five days every two months at the San. interviewing Toronto patients, A few
years ago a P.H.N, from Hamilton Health Department came up but she reported back that
there was nothing for the P.H.N, to do and so the relationship between the district
and the San. was not established. Miss Fenton says Mrs. Granat, social worker of the
Samaritan Club gets a more complete report than the N.D, on discharged cases and that
she follows up in the home. Arranged appointment to see Mrs. Granat,
Sat in on Miss Fenton's lecture to D.V.A. post-grads. See material on file*
See also copies of two other lectures "The Public Health Nurse in the Tuberculosis
Hospital" and " The Patient as an Individual Public Health Problem", Both Miss Fenton's*
In the latter raises the question of need for sterilisation of dishes for discharged
patients.
Wednesday. April 14. 1948
A.M. «• Appointment with Miss Maloney, service nurse for St. Elizabeth's, Order has
four nurses in Hamilton, one of whom has P.H. training. Cover approximately same
area as V.0.1. Do not send any reports to M.O.H. Have a medical advisory board -
any three doctors. M.O.H. not included. Feels there is little overlapping with
the Health Department because as a rule, she says, the Health Department nurse does
not get in before six weeks. St. Elizabeth's carry the baby for six weeks. If not
under the care of family doctor, then refer mother to C.H.C. Many doctors have their
own baby clinics. If mother returns from hospital and is not going to be under Doctor,
St. Elizabeth'd refers her immediately to C.H.C. and they will not go in.
Would like to have a staff of five nurses and prefer the P.H. trained.
Having a p.g. student from Toronto during May. In September w/ill start taking
intermediate students from St. Joseph's Hospital for nine days observation*
See file for statistics from St. Elizabeth's.
 -17-
April 14. 1948.
EJL. Interview with Mrs. Granat, Executive Secretary of Samaratin Club. Social
work training at U.B.C., 1939. Worked with C.A.S. Vancouver*
Mrs. Granat visits the San. every Tuesday morning where she interviews every
newly admitted Hamilton patient and does follow-up on other Hamilton cases as indicated.
Of perhaps four newly admitted for the week, she may carry two as cases. For the
others she will make out a card "No case made" to have for future reference.
Mrs. G. does all the T.B. social work for Hamilton cases. Contact with the
Health Department is practically all done over the phone and mostly with Mrs. Haygarth
rather than with the nurse who is actually carrying the case. The P.H.N, may phone in
about a case but from what I can gather, it would mostly be about material relief*
There seems to be a lack of understanding of what the T.B. case worker has to offer,
or else the feeling is that the case worker's field is quite apart and there is a
lack of working together on the case. Osier - "Tuberculosis is a social disease,
with a medical aspect". This is probably true, but isn't the nurse letting too much
go here by not maintaining closer contact with the social worker*
necessary,
Mrs. G. Gets full report on discharged cases and will do follow-up when
Discussed relationship between M.S.W, and P.H.N, Mrs, Granat thinks that
should be M.S.W's at Sa, Says the P.H.N's there are doing mostly social work,
(Miss Deeth on Tuesday said that she had made a very thorough job analysis of the
duties of her staff at the Toronto General Hospital, Only two items could be said to
be health education. All the remaining duties were those of a social service worker
and mostly called for case work skill)
Mrs. G. feels the P.H.N, should have courses in fcpychology, sociology and
enough on case work to give her an understanding of what case work is and to enable
her to recognize when the problem should be referred*
Samaratin Club is the Family Service for T.B. cases, 140 picked women*
All have to do some volunteer work. Raise large amounts of money and in addition
have grant from Community Chest*
 -18-
QgQRD COUNTY AND INGSRSOLL HE^ra~UNIT
Friday. April 16. 1948.
Drove to Woodstock with Dr. Baillie. Met Miss Grieve and Dr. Powers. As
the nurses were all to be in the Unit on Saturday morning, I stayed over to speak to
them. Commercial Hotel*
Saturday. April 17. 1948.
Oxford Unit has six nurses in addition to the Supervisor - Miss Grieve,
Miss Mackay, Seniors' nurse} Miss McNaughtin, Miss R. Grieve, Miss Walton, Miss Moore,
Miss Foster, There are also three students with them the month of April and there
will be another three next month. This group are from the University of Iondon.
Spoke to the whole group about the survey and distributed the forms. They all seemed
interested and willing to take part. Had a little discussion on the public health
nursing course. At London, both psychology and nutrition are compulsory. Social case
work is elective. If they do not elect it, they get nothing on social work except
as it is brought into the public health nursing lectures. Miss Mackay who took her
public health at McGill and had lectures from a member of the social work staff,
pointed out how valuable they were to her and that in public health nursing we need
so mai^ of the techniques used by the social worker. Caught 12.52 to Toronto,
Monday. April 19. 1948.
Came to Woodstock last night. Met Dr. Powers and Miss Buchanan (student)
at Health Unit at 8.15. A morning of immunization at five rural schools in Blenheim
Township. Met Miss Foster at the first school.
X -2-m   ScX^mX (f*»A    -ru*3 J
1. Ridewood School. Mrs. Cassidy, Teacher. 34 pupils* There one-half hour - Dr.
Grieve. 8 S.F., 2 vacc*
2* Muma School - Mrs. Smith - 10 pupils. Doctor gave 3 S.F., - 10 minutes.
3. No.9, Miss Culman. 16 pupils. Doctor gave 7 vacc. - 10 minutes
4, Wolverton - Mrs. Soarks. - 15 pupils. Doctor gave 1 S.F., 3 Vacc.
Vacc*
5, Springhill - Miss Hill - 18 pupils. Doctor gave IL S.F.,  1
The scarlet fever were all third doses and the vaccinations mostly
re-vaccination.
The immunization equipment is carried in a large tin box U^hing ***>•*
sterile towel is put over the topy tray and sterile syringes a^ needles F*«* £»"•
A sterile towel is put over them and they are ready for a second school. In spite of
ve^ cSef^ tecSi^e on the part of allconcerned in setting up the tray and ^eansing
lh7£lZ,  neither doctor nor nurses washed their hands once during the entire morning.
These five schools were quite a typical cross section I ^^e- *h* "f00
school board is gradually getting improvements made. Water, ^c^Pb?^J base"
™+ -i+fc furnace already put in Wolverton. Janitor problem difficult in all.
S^SlfSr.l^tSStar. terrible. Wash basin in corner mt*. looks as
though it had never been rinsed. Entrance not swept out.
Miss Foster has 30 schools - one, 3 roonsj - four, 2 rooms? - twenty-five,
one roo«. Wsits «ch aboj* once a »nth. Her headquarters are in.Dru*o.
t^SJSX S£E?^so^af JodiS in bloom in one 7eard.   Saw two
— -—■iftMifiiga—*
 -19-
groundhogs. Dr. rowers pointed out the marshes made famous for the &—wc
At lunch Miss Grieve told me about the little Anglican Church near guelph
where the man Florence Nightingale loved, preached. The family would not permit her to
marry him and so he came to Canada. Preached at this little church and while he was
there Florence Nightingale sent a communion set. This is now in a special place in the
church. The man died of T.B.
P.M.
Drove with Dr. Powers to Child Health Conference at Brownsville (about six
miles from Tillsonburg). This conference held in old library building. A new community
hall is nearly completed and very soon they will have space in it for the C.H.C. There
quarters are very cramped. Miss Grieve is the nurse in charge and a student was with
her. The student assisted with the immunizations and did not listen to the conferencing.
Perhaps that is because I was there. A volunteer of the Women's Institute weighed the
babies and pre-school childrem. The surprising thing was that the doctor seemed to be
present to do immunizations only. He only looked at one child and then only to examine
ears with auroscope because especially asked by the nurse. His work record for the
afternoon was the giving of scarlet fever toxin or combined or booster doses to 9
infants or pre-school children; third dose of scarlet fever to 10 school children who
had missed the last visit at the school and 11 vaccinations to infants or pre-school.
His day's work included the addition of the few immunizations done at the schools in
the morning. With the nurse in the hospital now doing intravenous, giving streptomycin, .
etc,, why in the world can't she do a simple intradermal test for scarlet fever and a
little scratch for vaccination/ (-^* CAumZLx.   u**zi  *>w 3J
If in this case, the immunization had been combined with physical examination
or some other work for the doctor it would not seem to have been such a waste of time*
In addition, if a student is not with the nurse it is customary for two nurses to go
with the immunization to the schools and to the C.H.C.
Dr. Powers goes to Brownsville C.H.C. only about four times a year for
immunization. The remaining conferences are held by Miss Grieve alone. She was very
nice with the mothers. She mentioned afterwards how difficult it was to conference
when it was an immunization clinic, Her space was not private enough and the chief
purpose the mothers had in coming was to get the immunizations. In her conferences the
questions asked were the usual about diet. Only once was toilet training mentioned and
that because the mother siad the boy had had a hydrocele drained. Nothing about sleep,
play, etc. Any records seen have ofily remarks in relation to diet and the obvious
things a mother would tell.
Babies not undressed to be weighed. Think this not good. One mother mentioned
she was still strapping the baby's navel. Doing it herself. Should have been inspected.
Only pamphlets displayed were the usual Metropolital Life, etc. No*reference made to
them. One woman (nurse) took one.
No hand washing facilities.
Attendance was 15 mothers with 8 infants and 14 pre-schools. Miss Grieve says
attendance at non-immunization C.H.C. averages from 5 to 10 (nearer 5)
Arlington Hotel, Tillsonburg.
 -20-
Tuesday. April 201 1948
Met Miss Moore, nurse for Tillsonburg and South Norwich at 9.00 a.m. Went
to her office until 10 a.m. Office consists of a small ante-room, a small office room
and a store room large enough to set up for immunization for C.H.C.
Population
Tillsonburg 4064
Township   2000
Schools - Tillsonburg, Public - 800 - 900
Separate - 150-200
High School - 200-300
Kindergarten - 80-90
Township, Consolidated 7 room school in Otterville
- 4 one room schools. Range 25*48 pupils.
Time divided:
Monday and Thursday a.i
9-11, Public School
one hour to kindergarten
Friday a.m.    Separate School
Wednesday, all day - Township Schools.
C.H.C. - two a month in Tillsonburg, one of which is immunization clinic. Average
attendance - 30 for immunization - 8 or 9 on other day.
- one a month at Otterville - average attendance 6,
- Mothers "go to their own doctors" - Dr. Powers only examines those who do not.
(Public Health Nursing service have to offer more if we are to get mothers to come to
C.H.C. Won't come just to tell nurse what the baby eats!)
For home visits to C.W., Miss Moore looks at birth announcements in the local paper.
Can make visit earlier than if wait for birth registration to come from Toronto. Tries
to visit within the first two weeks. At this visit gets the history. Only does
demonstration bath if arranged for before delivery - otherwise does not get in on visit
in time for this. (Could visit local hospital and make contact there for this. Over
500 babies born there last year - at least one-third would be from Miss Moore's
district.) She has only given two demonstration baths since she came last Fall. No
home conferences - although sometimes obstetric patients have to be in the corridor at
the hospital.
Pre-natal - only five being carried at the present time. None of these referred by
doctors - were picked up at C.H.C. Visits once a month to several months and then
every two weeks.
Tuberculosis - Has only three cases now. One of these is active and won't go to San.
The other two are arrested cases. Visits all these once a month. Has three contacts
to visit to see if had x-ray.
Venereal disease - has only had 4 contacts to look up. None found.
Mental Hygiene - has not referred any since she came.
Secondary school here is very crowded and there is just no spaae for the
nurse. She is in her office on Tuesday mornings and if needed they can call her.
 -21-
Otherwise no work done there. Miss Moore realizes the defect in this but feels she can't
do much about it. She is very conscientious but needs a lot of guidance and assistance
in developing new projects. Seems afraid to put herself forward. Is not sure but what
she would like to go back to institutional work - can see results faster. Here again,
we need to give our public health nurses more to work with - more to do for the patient, e.
e.g in infant welfare visits why not weigh baby and take temperature if for nothing more
than making an opportunity for the mother to bring up problems by reason of making the
visit longer.
10.15 a.m, made two home visits for measles (In same apartment house). One was about
a ten year old girl who had just broken out in rash. No temperature takem. Advised
fluids, keeping dishes separate and boiling since there was a 7 year old boy. Other
case across the hall also a ten year old girl who had just broken out and who seemd quite
sick. No temperature taken. Urged mother to get doctor and in the afternoon checked to
! see if this had been done. Suggested mouth wash.
i Visited nursing home - private - where most of cases are pensioners. True to form of the
way most co«ranities seem to be neglecting their old people. 12 patients and four empty
beds - both male and female. Very crowded. Mrs. Laymann probably gives^adequate
I physical care but that is all. Just nothing for the old people to do but lie or sit.
\ Although it was after 11 a.m. only one was up in a chair*
In the afternoon Miss Moore called at a school. Teacher had reported two
: children absent and thought chicken pox. Called at school to find out where a family
lived to whom she wanted to make an infant welfare visit. Did not inspect children
for chicken pox - nor did she when she returned to let teacher know that they did.
instil, visit to cases - One family. Large farm house. Little girl and boy. Both broken
I out on Sunday. Very few spots. Boy's healed but advised to keep out all week.
f s,„-?s--n2: x sir.srss: ssrs m;„fs iss rs»>
| BLrxsttmttrmZVtfi s^sssrsr.—-   .
1     Nurse had left a card and asked her to call if wanted anything.
2.    If nurse had wieghed baby - undressed and temperature.
£ !2& SftSiSS/Ui JSTXZZtttZ   ]af- 10 graduate nurses,
1 assistant nur«, 2 practical nurse category and one ward aide.
Miss Carson did not appear very professional - no cap, brown shoes and
stockings but Siss Moore said she ran the hospital last year without deficit.
I Evening - with Miss Mere to "-""•^"^J"^"^^. ^S-
i Norway.     yd^d^^^f9^
Jim* 3. 1948
P^w, to going ^^^l^l^Tto^T^^^^^
^^^f^U^C^lL^aUrEesearch. S.nt complete forms to
 -21a-
Wednesday. April 21. 1948
With Miss Moore to two schools. Miss Moore checked vaccinations for about a
dozen children and weighed all childrem. She has weighed the class three times since
September. No reference made to gain. Says teacher records, (I did this which was
probably why she did not ask her.) Then went on to Otterville School. Six roomed
consolidated. Miss Moore checked some vaccinations*
Back to Hamilton by bus and 5.15 train to Toronto*
April 22 and 23. 1948 - Attended sessions of R.N.A.O. Annual meeting. Miss Fidler,
President. Spoke about survey at the Public health section meeting, Friday morning.
April 26. 27. 1948. - Attended sessions of Puboic Health Officer's Association in
Hamilton. Speakers of note: Dr. Vaughan, Dean of School of Pubftie Health, Ann Arbour -
urged M.H.O's to get the support of the public through key lay people - suggested as a
means of recruitment that a scheme be developed to qualify men for both clinical medicine
and public health.
Chancellor Gilmour of McMaster in his speech entitled - "The Little More and How Much It
Is"., urged the addition of the larger interest to our ordinary work.
Professor Bladin's topic - "Working Relationships" had much which can be applied to our
work, e.g., rest-break, interest in staff nurses' work, etc.
April 27. 1948 - Came to Woodstock last night. Commercial had cancelled reservations ss
had to stay at Mrs. Amos' Tourist Home.
Out in district with Miss Walton. Miss W. had a year and a half in the army,
a summer with the V.O.N., Public Health course at London, Ont., and came to this Unit
last August. She has the townships of East Nissouri and West Zorra, inlcuding the towsa
of Embro (office there) and Thamesford. Total population, 4»80O. She has 23 schools
and two High Schools.
As with all the nurses, her case load is chefly schools, pre-school and infantse"
She has no T.B. eases, only one V.D., who is under treatment add three pre-natal. In
explanation of the small pre-natal case load, she says that the doctors do not appreciate
the service the nurse can give and moreover, in the country, many of the pre-natals do
not want neighbors to know of their pregnancy and do not want the nurse to call. Is the
answer here not that we must demonstrate that we have something of value to give in our
[visits? Same applies'in C.H.C. which are poorly attended.
1* Visit to #7 School. Teavher, Mr. Bender - no training.  Uries to wei^i 30 pupils
each month. Teacher does not help. Got five beginners ready for doctors examination
j next month.
§L Harrington School - Miss Smith - 36 pupils. Weighed and measured all class.
I Measures 2x year. Told children of gain or loss (See School Visit No. 4).
In afternoon made five home visi/tsf (See Home Visit No. 6)
Drove back to Woodstock via Thamesford. Very pretty community and surrounding eountry.
Miss Walton has a very nice approach to teachers, children and mothers. Inspires confidence. Seems to have good knowledge. Interested in her work.
In relation to schools - a trained teacher of Manual Training and Agriculture,
spends one-half day in each school; a music teacher spends one hour a week (Mostly theory
and not very practical) and a projectionist, with films once a month. A nutritionist
 -21b-
visits and helps out with hot lunch programs in the winter.
Thursday. April 28. 1948 - To Ingersoll, Ont. with Miss Ruth Grieve.
At Denham School, 2 rooms (24x18). Miss Latimer, principal. Miss Grieve inspected two m
new Grade L pupils and tested eyes. Good individual teaching with these. Tested hearing
of two Grade I children referred by teacher and confarnnced with teacher about them and
others. Thought she missed the point in relation to one of these little boys. The
teacher complained of him being listless, day-dreaming and never getting his work done.
Was keeping him (and other little ones) in at recess to finish arithmetic. His hearing
seemed O.K. Said she would have the doctor see him. When I mentioned Mental Hygiene
Clinic later she seemed rather surprised that he should be considered - "Would want to
observe his more first before alarming mother". Did not mention anythihg about visiting
in the home to discuss his day-dreaming with mother. Miss G. did not say anything to ±k
teacher about keeping him in.
While in the senior room a health lesson was going on with Grade 6. Teacher
was reading questions from what was presumably a prescribed test and children were
writing the answers. Soke of the questions were -
Name the four parts of the heart? To what mechanical apparatus can the heart
be compared?
What is haemophilia? Name the main arteries?
All factual! What about interesting projects to teach how to live healthy?
Made two home visists - follow-up of hearing defect and youngster who had been hit over
the ear - (See School Visit No. 5) and Home Visit No. 7)
Lunch in Ingersoll with Miss M. Grieve and Miss Smythe (student)
At C.H.C. in afternoon with Miss MacNaughton, Miss Pickering, student there alsc
Mrs. McFarlane, volunteer* C.H.C. held in Y. rooms. No other activity there them.
C.H.C. held weekly and one week a month the doctor comes for immunization. At these times
about 30 attend. At regular clinic 8 to 10. Only four to-day. Miss MacNaughton very
upset about the small attendance. At immunization clinic, four rooms are used. These
are available for all clinics if wanted but only one is used. This means lack of
privacy. "Our Baby" booklet only educational material out and this not referred to at
all. Two health posters in room (See clinic visit no. 4).
Miss M. Grieve and I drove from Ingersoll to St. Thomas and had dinner with
Miss Horton and Miss Jones. Most enjoyable. Miss Jones returning home in July. Has
part of city as her district. Mostly school wo$k. Says very little C.N. work done.
Reason: most go to own doctors and we have nothing special to give in C.H.C's, Drove
to Port Stanley after. Terrific sanitation problem there.
Friday. April 30. 1948 - Wrote reports, obtained statistics from office, conference with
Miss Grieve. Assisted Miss. G. in evening with pre-natal visit script for local radio
program.
Saturday. May 1. 1948 - Visited market before 9 a.m. Maple syrup - $1.10 per quart
plus 15^ for jar.
Conference with nurses who had completed job description and school information
questionnaire,
 -22-
Miss Nicolle for her comments*
C a^,. o-c^t. v» p it ]
meeting in Vancouver was very successful and the weather man certainly
did his part to make the stay there a very enjoyable one for, I think, most of the
eastern visitors. Sessions were very good and there were many very interesting papers
given. The difficulty was that it was Impossible to get into all the Section meetings
and hear the various speakers*
Returned from Vancouver, Saturday, May 29th, having left on May 25th. Phoned
Miss Keefer and made arrangements to do some observation with the Hospital Health
Service of the Toronto Health Department*
Hospital Health Servicesn Toronto Health Department.
Bet with Miss Keefer and Miss Carrol on Tuesday to discuss visits to hospital
health sefvlce. Miss Carroll is the supervisor of this service and there are some
twenty public health nurses in various hospitals ln Toronto* The Toronto General Hpl*
has their own set-up. In the hospitals where tare is this service there are no social
workers. They stated that Hospital Health Service nurses do the necessary social work.
In the Toronto General Hospital however, there is a social service department under
Miss Deith. Nevertheless, all of her staff, with the exception of one, are public
health nurses, (a written description of service is in folder.) Miss Keefer and Miss
Carroll were most anxious that I get a good picture as they feel very definitely that
it is a most Important link with the District.  This point is very much emphasized.
They feel that it is most valuable to have a member of their own staff in the hospital,
otherwise, the link would not be so satisfactory. Nurses who are assigned to this
service are specially picked and all have had several years experience on the district*
On Wednesday morning I reported to the Health Service of the Toronto Western
Hospital. Miss Bird is in charge and there are four other nurses. Miss Rows, Miss
Nettleton, Miss Webb and Miss Smith. There are definite clinics at which these nurses
are present. These clinics are, V.D., both male and female, neurology, heart and eye
clincis. Diabetic and chest clinics. The other clinics are not necessarily served by
the nurses, butt their services may be requested when necessary. Pre-natal clinic also
is one at which the nurse Is always present, Miss Webb seems to be responsible for this.
The clerical staff Is rather small. They have one for one full day and two half days
per week, and there is one clerk working full time on the V.D. clinic but she is a
hospital employee* As previously explained, the nurses act as a link between the
hospital and the district, sending information out to the nurses on new admissions and
on any special cases. They also attempt to do what they refer to as "social work".
Requests may come from the wards for the nurses to visit special patients. It is also
routine for Miss Webb to visit all maternit cases who have been through the pre-natal
clinic.
Perhaps the best way to record the observations made would be to write down
the conferences as observed with the nurses during the two days at Toronto Western Hpl.
Following the initial interview with Miss Bird, I was introduced to the
various workers. I then spent a little time with Miss Smith who was "on the desk".
Apparently when the nurse is serving at the desk she is available for any calls which
might come in. If they relate to any of the special clinics, as mentioned above, and
for which one of the five is definitely responsible, she refers the problem to that
nurse. If they do not relate to any of these special clinics she tries to handle tha
problem herself. I did not observe with Miss Smith very long because everything segmed
to be very confused. There was a Neurological Clinic on at the time. Miss Smith/called
by a doctor to take a woman who was an epileptic out and arrange for some place for her
to have a rest before returning home. I accompanied Miss Smith to the office. The
woman was extremely upset and was trembling, however, the doctor thought she was ready
to go out to another room. It was decided that she would rest and the ambulance would
be called. As she left the door she fell into an epileptic fit.
Another case she was
 -23-
attempting to do something for was one that was reportedly Addison's disease and had
bean referred in froa the Salvation Any. She was trying to get more information from
the District. A third case was a conference just standing in the waiting room of the
Out-patients department. A woman was trying to get some assistance in relation to a
clinic she should go to. She discussed her whole family history right there. I did
not stay with Miss Smith very long, but it does seem to me that being on the desk, the
nurse serves as an errand boy and does everything which nobody else seems to be
responsible for.
I then went with Miss Nettleton to the Eye Clinic for which she is responsibl*
three mornings a week. By responsible, I do not mean that she is responsible for the
administration, it is her duty to be there to check the cases which need her. We
stood there for some time but there did not seem to be anyone who was going to require
her services. I believe that her work would be chiefly seeing that glasses could be
obtained and arranging for the finances, etc.
Then went with Miss Webb to visit patients in the maternity ward. We
entered the ward without first contacting the ward nurse or referring to any  charts.
The patients visited were in two eight bed wards,
1, A mother with a day old baby. The mother was giving the baby its bottle at the
time. The nurse's first remark - "You only got in once to see us at the clinic", and
then - "Are you not going to nurse your baby?" She followed this by a talk, which
was almost scolding, on the value of breast feeding over bottle feeding. By the look
on the mother's face she somewhat resented all this. The nurse then told her to be
sure to come back for her check-up at the end of six weeks. Never once did she refer
to the nice baby which the mother had in her arms, I believe this case was also a
V.D. but no mention was made of this*
2* A mother who was nearly ready to go home. She had a rather low I.Q, and was of
foreign birth. The nurse reprimanded her about coming to the clinic only once, and
told her to remember about the nost-natal examination,
3* A mother with a five-day old baby* She was feeding the bab$ at the time. Told
the mother to remember about the post-natal examination and said - "Aren't you going
to nurse your baby".
4* A young mother whose baby was not with her. Asked her how she was feeling and
said that she was up ln the case room with her. The mother had apparently called for
Miss Webb. Told her to remember about her post-natal and said that the ward nurse
would be giving her a card with the date. The mother asked re the hospital bill,
about which she was somewhat concerned. The nurse said that the Finance Officer would
come to see her*
5* Mother with a one-day old baby. Launched right in on a discussion about breast
feeding* This mother had every intention of nursing her baby, and fully realized the
advantages*
6* Mother with a two-day old babfr. Asked her how she was feeling and told about
coming ln for the post-natal examination*
7* Mother with an eight day old baby* Mother immediately asked the nurse about
inverted nipples. The nurse started to talk about breast feeding the babfr and its
values; at this moment the ward nurse came and when she could interrupt the conversation she explained that the baby was upstairs, meaning that it was a premature and
was not being nursed, and that they were making arrangements for manual expression of
the milk. Here was a case where the nurse (public health) was not fully informed.
She had not checked with the nurse on the ward nor had she looked at the chart. She
night even have gotten more particulars from the mother before starting in on her
little scolding.
 -24-
8, Mother with a three day old baby. The nurse seemed to be acquainted with the home
conditions. Apparently a family of six lived in one room. The father had Just been in
jail for a month. Mother said that he had returned home the day she came in. Nurse asked
who was looking after the children, was told that the Catholic Welfare had taken them*
Nurse asked if they would keep them for two or three days after she went home* Mother
said she thought they would. Nurse said that she would phone the Welfare about this*
This phone call was later made* It seemed to me that this was hardly necessary because
the mother had made all the arrangements herself*
This completed the visits on the ward. It seems that it is the policy to visit
at least once during the stay in hospital. The patient stays f*om eight to ten days.
Did not check to find out the information which would be sent to the nurse but, presumably
it would only be the birth registration or, if there was a special need, some Information
would be sent to the District Nurse for follow-up*
In the afternoon observed in the pre-natal clinic. Miss Webb was the public
health nurse. Miss Webb's office was an outside office next te the two used by the
doctor for interview and for examination. In order to get to the doctor's office it was
necessary to go through Miss Webb's office. Also the scales for weighing were in her
office. When a mother was called in to be weighed she might go back to the hall to wait
or she might go through to the doctor. When she was finished with the doctor she mama
back through Miss Webb's office to the hall to wait for her Interview with Miss Webb,
The public health nurse sees all the patients who attend the pre-natal clinic.
There is usually a volunteer who weighs, keeps the records straight and sees   .
that the mothers get in to the doctor In order. The volunteer was absent and a student
was acting. She was very efficient* One could not help but feel that had it been a lay
person it would have been another obstacle to the mother telling her problems to the
nurse* (The scales could have been elsewhere,) As it was, the problem of so many people
travelling through the office was a very great hindrance.
There seemed to be a great deal of emphasis placed on getting the records in
order and ■»*•<«£ sure that the appointment card was out and marked. One did not get the
feeling that this was going to be a smooth conference, and that the nurse would impart to
the mother that she had plenty of time to listen to her and encourage her to tell her
difficulties*
The conferences were as follows -
1* Nurse read the doctors notes, said "Can't find anything wrong with you at all"* This
mother was in her ninth month of pregnancy. Asked her if she was resting, asked also
about her iron pills* Checked this mother about her crossed knees, spoke about diet and
this ended the interview* No notes were made on the chart. It does not seem to be the
policy to do this as none were made subsequently. This interview took about a minute and
a half*
2* The patient sat for many minutes while the nurse was fiddling to get her desk in
order* Asked the patient regarding rest, appetite, etc. Seemed to me the doctor had
already done this. Gave her an appointment to come back*
3* Mother in eighth month of pregnancy. First remark - "Can't find anything wrong with
you to-day except that you have gained a bit of weight. Are you taking soft drinks?"
Gave appointment to return in two weeks.
At this point the hospital nurse came in to ask publie health nurse if she
could get a pair of elastic stockings for a patient. I wonder if this is not rather
typical of the type of request which cones to the nurse, the supplying of material
relief. I have not seen any evidence of case work yet*
4. Mother in her ninth month. This mother had had chorea as a child. I later read the
medical history. She was an unmarried mother and was extremely nervous in her movements.
 -25-
She had just been out of hospital having bean ih for a heart condition. Said to the
mother - "Ame you getting plenty of rest. You've got to get plenty of rest. Are you
going to keep your baby?" And then an appointment was made for the next week.
In discussing this case with tha nurse afterwards I was told that this was
quite a social problem. The girl waa living with her aunt and uncle, she was planning to
keep her baby, but the nurse was sure that it was not a good arrangement* A few little
notes with this social information wars scribbled on a place of paper attached to the
appointment card. Not a single mention was made of this matter in the folder which
contained all tha records used by the doctors and others in the hospital* Hera Indeed,
was a ease needing a great deal of intensive case work*
5* A mother who had been coming regularly. Asked her "How much rest are you able to get,
who will look after tha little girl when you come to hospital?" The mother asked regarding paint fumes, said that she had heard that they were very bad for an expectant mother*
Nurse explained that it was no different when she was in that stats than at other times*
If they nauseated her generally, they might then*
6. Mother ln her eighth month. Opening remarks - "Did they take some blood from you
to-day?" Then nurse read the doctors motes, partly aloud* "Are you having some trouble
with constipation?" Then she went over the doctor's suggestions* "Your diet is Improving,
are you taking some raw vegetables?" Then she gave some suggestions in regard to constip- ,
ation and referred to the training of tha baby* Said that it could be done at two months
by sitting it on a small pot*
7* Opening remarks - "Did they take some blood froa you to-day*
Everything is fine*" Gave her an appointment to return*
Are you feeling alright?
8* Mother in seventh month. Wanted her to go for an appointment at x-ray. (It seems
routine that pre-natal cases are given a chest x-ray. This is usually done at the time
of their first visit* (It was not convenient for this mother to go to-day so it was
arranged that she would on her next visit*) "Are you feeling alright* Are you getting
enough rest?" "How about the other children*" This mother had high-heeled shoes, but
nothing was said about this. It was noted also that there were two or three other
mothers wearing very poor footwear, considering that they were so far on in pregnancy*
This fact was never mentioned.
9. Openeing remarks - "Well Mrs, Casey, can you go up for x-ray to-day?" She then
asked her about her diet and weight and gave instructions for going up to tha x-ray
department. As a natter of fact, for everyone who had to go to x-ray department quite
elaborate Instructions wars given, taking time and effort.
10. A woman in her ninth month, who had on very high heeled shoes. "You most get plenty
of rest until you come in." Gave warnings about what the signs might be when she would
be starting labour and what she should do in relation to coming ln to hospital.
11. An unmarried mother whose baby was due. Told her to come back a weak from to-day if
she was not in hospital before.
12. Mother in her ninth month, "Everything is find, soma back ln two weeks," Mother
reminded the nurse of tha x-ray. Nurse gave instructions about going. The mother was
under-weight bat she did not ask her about her diet*
13. a mother who was working. Nurse checked her address and asked her if she would go
up for x-ray, gave her tha slip and instructions. Alma gave her an appointment to coma
back four weeks from to-day.
After tha mother left the nurse told me this was a special case. They were not
sure that this mother was married, thought that she was living as a common-law wife.
They also knew that she had another child, but no one seemed to know where it was. Here
was another case for Intensive social work and nothing being done. Just a few notes
 -26-
were scribbled and attached to the back of the appointment cart.
±her ™ i^W ^^J"^ "*e TO,ad haTe liked *• >««- — 70" earlier". (The
£^ L^S-tJf ££..wvA Th^,the m,r8e dl800T««i «** th. mother had just come
a University student. This was a very intelligent mother. Nurse filled out toe appoint-
%£ ^t^t1S:S:din! ^^riulr0,, pLLL''   6m h« the hea"» depart.** booklet,
^ ^LTttTSS I ^f^ " «»e had any worries. Gave her an appointment to return.
She was not told that a district nurse would visit*
15* New mother. Prinapara, in her fifth month. Opening remarks - "You did not get in
nearly early enough to see us." Asked if she had had any other pregnancy. Took tha
information for the appointment card, asked her what her husband did, gave her an appointment to come back in one month.
These were all the conferences I listened to. They occupied about an hour and
a half of time. At this point, Miss Nettleton came and asked if I wanted to go on the ward.
the wards.
Visits with Miss Nettleton re V.D. cases which had been referred and were on
1* A woman who was getting penicillin. Nurse read the chart but there was not a sufficient
amount of information on it. When she interviewed the mother it was rather obvious that
she was probably a private patient. Woman remarked that "it just gets on ny nerves."
There was no follow-up done on this. It seems it is routine when such cases are reported
and they are on penicillin that the nurse must make out a slip and send it in to the
Provincial Health Dept. The private doctor had to fee contacted in this case before the
nurse could do anything more,
2. Found that the case had been discharged a week ago,
3. Found also that the patient had gone home*
4. An old man about seventy-one who had been referred for placement. In talking to the
nan it was found that he was quite an independent chap, that he was going back to the room
which he had left before coming in and that he had plans to apply for the aid age pension
when he got out. There was obviously no particular reason why anyone should be concerned
about arranging placement for hia*
After visiting with Miss Nettleton we went back to the office.
Thursday morning, observed in the chest clinic with Miss Bird. Clinic was
going on at the time of arrival. Here too, the nurse seemed to be very concerned about
getting her papers straight and records in order and appoihtments made, etc. There was
considerable getting up and running around. Her desk was in the hallway almost under the
stair case. There was very little opportunity, in fact there was no opportunity for
private conversation. A volunteer sat beside her. This volunteer ran errands and marked
appointments on the card.
Conferences in chest clinic
1, Woman came to get appointment for lipiodol. Nurse explained what lipiodol was and
why they were giving it. However, her esplanation was not very good and it most certainly
could have been given by another nurse. Quite probably it was given already by the doctor.
The patient was reading parts of her report as the nurse was making out the slip, A
second patient was standing reading over her shoulder. Nurse gave her the instructions
to go up for tha x-ray,
2. An x-ray appointment for a patient and date given to return to get report.    Weight
wL, chec^andasked where she was working.    It seems *™^_^* "*" EFEL°Z5
in for examination she is given an appointment to go upstairs for an x-ray and then date
 -27-
^ J! £?L?l t !!°r £ read* He does ** 8e* th* *-*ay «1» before the patient
comes in to get her report. Thus all negative cases come in also. pa*xen*
3. A patient who had formerly been in the sanatorium. Discussed weight and exercise,
!f hTL^t18 °rdf S\ **?**■«* «i~ to return in two months. Thif^aUeit
had had exercise increased. No notes were made on the chart in this case or any other case*
4. A woman, an older patient. Given an appointment for x-ray and told to return for
reading of the report.
5. An older man who had formerly been in a Sanatorium and quite probably was having
increased activity. Nurse did not know the man's name although the doctor had given it
to her. She called a student and said "would you weigh this man." The patient then came
back and the nurse continued questioning. He said he had had a skin test. Nurse said
she would give hin a note for the private doctor. The patient had already stated that
the private doctor had told him to let him see the.test in 48 hours and it did not seem
that a note was necessary. However, it was a routine matter and the nurse told the patient
that the doctor would report the result of the test and that he should bring this paper
back with him when he came next week. An appointment was given for that time. Her parting
words to the man were - "You give that to your doctor and show hin your arm." Much as
though he were a little boy. This was an intelligent patient and he did seem to think  or
that all of this was a little bit absurd. She then said - "Don't forget to go to your doct
on Saturday,
6. A patient who had formerly been in the Sanatorium, The nurse read over the doctor's
orders and as she was reading them just seemed to look to the patient for confirmation
that everything was o,k. An appointment was given for x-ray and she was to return in a
week.
My impression of this clinic seemed to be that the nurse is just used to give
appointments, There did not seem to be one thing that a clerk could not have done or as
far as the professional side is concerned, would not already have been done by the doctor,
or could not have been done by another nurse. In fact, there was nothing done that
would have made any difference if omitted. 1
Then went down to the Diabetic clinic where Miss Howe was the public health
nurse* Walked into her office where she was sitting on a stool at a desk interviewing
a patient* There were four other patients in the office at the time. Her room was very
small, tso of these patients were sitting, the other two standing, they were Jewish and
they were all talking in Yiddish*
1, An old nan and aha was explaining to him when he should come back and that he should
take a bottle to bring in a specimen. She put his name on the inside of the bottle and
gave it to him,
2, A woman who did not seem to having any difficulty, A return appointment was given*
3, A man who apparently had just had diabetes diagnosed. A V.O.N, had been in and
taught hin how to give insulin and he was now able to give it to himself. The nurse made
arrangements for hin to get special assistance in the way of diet* Apparently it is
customary for groceries to be delivered once a week from Simpsons* In order to do this   jl
she would have to send a note to the district nurse who would call around. The
Welfare Dept* would then be contacted and they would call. She gave hin a new needle for
his hypodermic*
4* A Jewish woman. A doctor had ordered that she the dietitian. When she sat down with
the nurse she immediately started talking about her diet and the nurse said that she would
take her to see the dietitian. The nurse gave her a re-appointment. In this case the    r
on]£ thLTthat was dona by the nurse was the giving out of the appointment, and the patieni i
had waited twenty minutes just for this*
 -28-
5. An older woman who was now not taking insulin. Nurse said - "AaVe you gaining
weight again?" Re-appointment was given. The patient went down to the Emergency to get
her medicine and while she was there the nurse went to order an ambulance.
Asked the nurse about the cases she referred to the District. She sends a slip
on all new cases and then any which have a special problem. When it is a case of teaching
to give insulin she contacts the V.O.N. Here there does seem to be a rather strange
situation. The patient may be diagnosed diabetic. Instructed in the out-patient's
department if he has to have insulin. V.O.N, nurse goes ln to teach him to give insulin.
Follow-up is done by the district nurse. Would it not be much more logical to have tha
District Nurse make the initial contact and teach the patient to give the insulin?
In the afternoon attended the regular monthly staff meeting of the Hospital
Health Services group. This is held in the waiting room at St. Michael's Hospital.
Miss Carroll in the chair. She asked me to tell about the Study. Following that, their
meeting consisted of going over the holiday list and checking on two or three routines.
Would question very much if very much educational material is put across at these
meetings.
June 4. 1948.
Visited Hospital for Scik Children, Hospital Health Service Dept. About five
nurses in one small room. This room situated in the centre of the Out-patient Dept. In
the clinic itself there is no space for the public health nurse to be present at the time '
of the doctor's examination or to interview parents. Apparently there are one or two
clinics which the nurses are on the spot. For the remainder, the doctors supposedly,
bring their problems to the nurses. Some of these nurses work part-time in other hospitals. As far as can be determined, the nature of the problem is chiefly supplying
surgical equipment, home dressings, etc. The hospital health service also looks after T.B.
admissions to Sanatoria. Tries to get the consent from the mother and notifies the San.,
or if there is not a bed there, the Convalescent Home. The Convalescent Home wound send
a car. Then, if the mother should refuse to have the child go to hospital, a note is
sent to the district nurse for her to go in to see if anything could be done. If she
cannot persuade the mother then the district medical officer is called in. And if he
can't do anything about it, the problem is referred to the Director of T.B. Control. If
it is still unsettled the matter can be taken to court. It does not seem to be the policy
to call in any social agency, except in the case of placement.
The nurse stated that one-half of the job in the Hospital Health Service, is
clerical work, a great deal of which could be done by clerical assistance. One nurse who
had just been in the Department for three or four days was sitting at a desk copying
information from ear, eye and nose and throat charts of cases which had been seen by the
doctor at the clinic. She uses her discretion about the ones which should be referred to tl
the nurse in the district. She had not seen the case or talked with the mother. This was
a purely clerical job and not one which would be very stimulating to a nurse with her
degree and a great deal of experience. This happened to be Miss Frances Pearl,
As it did not seem to be a day that I could have very much opportunity to sit
with the nurse when she was conferencing, I made arrangements to return on June 21st,
This was later cancelled because on that date they were taking on three new nurses.
Further visits to the Hospital Health Service will be made later on in the year.
 -29-
CAHAPIAN ASSOCIATION OF SOCIAL WOftKmg » MEDICAL SOCIAL SERVICE INSTITUTE.
June 8-11. 1948
Th18 Institute was conducted every morning from 8.45 to 10.20 a.m. during
the four day session of the Social Work Association annual meeting in Hamilton. The
Institute was conducted by Miss Margaret Johnston of the University of British Columbia.
At the first morning she stated some of the principles of social work.
1. Social worker recognizes the right of the individual to make his own plans,
provided that it comes within the limits of safety in the community.
2. Social worker recognizes that all behaviour is motivated.
3. Social worker recognizes that the patient is of the family. He is not a unit, a
case, etc* She stated that we all have a common interest in the person, to help the
individual find a healthy, a satisfying life.
Discussion - This institute was attended by over forty workers engaged in some form of
social work. A great many of them were D.V.A. There were some who had not had any
training in social work, some were nurses mho were endeavouring to do a social work
job without any special training apart from their nursing. Others were nurses and also
trained social workers. It was very interesting to hear the discussion of all these
groups. Because of the diversity of the class it was necessary to give only the
elementary principles of medical social work. The discussion on the first day centred
around the questioh - "What is the medical social worker for?" "What is her function?"
Her functions are -
1, She gives case work service to the patient. She does those things related to his
illness. Those things which are related to other problems are for referrals to other
social workers in other agencies.
2, She is part of a team. The direction usually comes from the doctor. He has in
mind certain treatment and the case work may be the tool he uses in achieving the final,:
result.
In the matter of referral it was decided that the referral should usually
come from the doctor. The nurse may recognize the problem, she may discuss it with
the doctor before she refers it to him or referral may come from the public health
nurse in the district and sometimes from the patient himself. It was stressed,
however, that the doctor must know about the referral and it is better when it does
come directly from him. If problems are handled without the knowledge of the doctor,
then he is not being educated In the use of the medical social worker in treatment*
Dr. Winfield, Psychologist for the Board of Education, Toronto, stated that
the public health nurses do a lot of medical social work in the schools. Felt that he
did not really understand the meaning of medical social work. This confusion must
result because the medical social worker and the nurses are themselves confused about
their own work. The work of the nurse is that of health education and she should have ;
sufficient knowledge of social work to recognize the problem and to know to whom and
how to refer it to the proper worker*
In summary, Miss Johnston stated that the main function of the medical social :
worker is to do case work with the patient. The patient who comes to the hospital or  |
to the health clinic may be unaware to the extent which his social problems may be
intensified by his illness. Joint planning must begin at the point of referral and
it must be fitted into the total social plan. How far does the medical social worker g
go? How long is the feeling, how far can she meddle in personal problems and deeply  , ■
laid patterns of personality. She can only know this through professional training
 -30-
and experience. It is not just common sense. How far she can go in treatment depends
IZL \ ^"  * °n the Patient and °* her problem. 3. on how far the doctor
wants her to go. 4. on co-operative planning. This co-operative planning concerns the
doctor, the ward nurse, the public health nurse and to a lesser extent, other personnel
In the hospital and other agencies in the community. As yet, we are ohly scratching
the surface in co-operative case work. ■
On the second day, the session started off with a summary as above, and then
the meeting was thrown ©pen for discussion. Examples were invited of the type of work
which is done and discussion started out witji the things a bed-side nurse could do
Instead of a social worker. It was suggested by one person that the bed-side nurse
could arrange with the V.O.N, for injections, could notify relatives in case of serious- >
ly ill patients. Miss Johnston stated that a criteria for decision as to who should do
the job night be
Would this have to go on if there was no social work department in the hospital. She
feels that we have not explored nearly enough the use of trained and intelligent clerical staff.. There may, however, be the situation in which you have to say "at this time,
and in this place and for this reason" it has to be done this way. This does not mean
that at a later date it might not be changed. Progress comes slowly but surely. The
third thing which the bed-side nurse might do is to arrange for transportation.
Discussion brought out that this should be a clerical job. Another matter for the bedside nurse would be the referral to the public health nurse. Sometimes this is a joint
responsibility between the ward nurse and the medical social worker. If the case is
known to the social service department then it would probably be best for the referral
to be made through them. If the case is not known to the social worker then it could
be referred directly by the nurse on the ward.
The matter of social admitting was discussed. In some departments all new
cases are automatically referred to the social worker. It seems that this practice
started in the early days because they were not getting the early referrals. This
planning for tha automatic pick-up of problems breaks the basic principle of referral
by the doctor and it is rather presumptuous to attempt to do this. This method also
pins the social worker down to being in every clinic and to see every patient. It was
admitted that there are certain types of illness for which every patient should be seen,
for example, tuberculosis and venereal disease. But it was felt that many medical padtioa'
patients do not need to be referred to the medical social worker.
One worker brought up the matter of disciplinary problems among the tubercul- -
ous. Apparently she was engaged because it was felt that she could handle those cases
who were signing themselves out of hospital early or who were going off for days at a
tins. Miss Johnston referred back to one of the principles of social work. All
behaviour is motivated, and asked - "why is the patient showing this kind of behaviour".
Certainly there were cases for the social worker to handle but perhaps not in the same
light as the administration in the hospital at first engaged medical social workers.
It is the function of the  medical social worker to find out the reason why the patient
is leaving the San. Let him talk it over, she may serve as a steam valve and help him
to accept the rest gradually. She also has a function beyond this. That of interpretation back of the doctor, the nurse, the administration and others*
On the third day a panel discussion on "Relationships between the medical
social worker and the nurse" was held. Personnel of the panel - Chairman, Miss Margaret
Johnston. Discussion, Mrs. Richardson of the D.V.A., Miss Clarkson, English Almoner,
Miss Tennant, Director of the Medical Social Department of the Montreal General Hospital
and Miss Creelman*
Mrs Richardson started off the discussion with the relationship between the
medical social worker and the psychologist. She pointed out that in any team, the
functions must over-lap to some extent and we must not be afraid of that over-lapping.
My function on the panel was to bring out the relationship between the medical
 -31-
social worker and the public health nurse. The following is a summary of my statement -
More and more in the public health field we are beginning to realize the social aspects
of disease. We have long neglected them. We know that a high percentage of tuberculosis
and venereal diseases have such problems and these two diseases are two of the most
important problems in public health. The functions of the public health nurse are briefly
1. the nursing eare of the sick in their homes.
2* participation in measures for the prevention of disease*
3. education of families in matters of health*
What preparation does the nurse have for this? She is first of all, a registered nurse and then she takes a public health certificate or degree. During ner last year
she studies public health subjects and psychology, sociology, mental hygiene and has some '
orientation to social work. It depends on the university in which she studies as to the
amount of this orientation. It also depends on the university in which she studies as to
the type of mental hygiene instruction which she receives*
The public health nurse is not trained to do social work. Public health nursing is, ln itself, a specialty enough. The nurse should, howevez; be trained to
(a) recognize the social problems,  (b) know how and to whom to refer the problem for
treatment*
I believe that the medical social worker might also be used as a consultant on
the staff of health agencies* So far, in this institute, we have been discussing the medical social worker in the hospital setting only* If I may quote from a new book which
has recently been published - "The Rehabilitation of the Patient", by Mrs* Ellidge, ln
which she has a chapter on the medical social worker as a consultant. The following
paragraph is, I think of interest -
"When the medical social worker acts as a consultant in an organization she uses her
knowledge of medical implication and her case work skill to advise other persons in the
agency oh medical social problems. Difficulties in accepting the need for medical care,
personal reactions to physical impairment and its effect on the service which is being
offered and so forth. She may provide such consultation services as a part of in-service ■■■
training for a staff of vocational counsellors or nurses. This includes discussion of
individual problems through conferences in which the staff worker brings records for
discussion, or by an interview with the person concerned at some strategic point. Following which, she confers with the worker who is to provide continuing service. Whether or
not she provides direct service to individuals in these programmes is Influenced by the
scope of the agency services, the availability of case work services in the community
and the nature of the problem."
There will be over-lapping, but as Mrs. Richardson says, we need not be afraid
of the scene if we sit around a table and work out our problems together. Whether they
are problems of general policy or just one case that we are deciding who should handle
the problem, our questions must always be "what does the patient, or the family, or the
community need." "Who is best prepared to help meet that need"? and, basically, what
training or preparation does the individual worker, nurse, medical social worker, etc.,
need to carry out her function.
Miss Clarkson then discussed medical social work as performed by Almoners ln
England, and also told of the training whieh is given.
Miss Tennant, Director of the Medical Social Service of the Montreal General
Hospital, gave her views as a nurse who had taken social work training. She stated
specifically that the two years is absolutely essential, even for the nurse, before she
could be qualified to do medical social work*
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On Friday there was another panel to consider relationships between the
medical social worker and the doctor. Two doctors entered into the discussion -
Dr. Bailey, Psychiatrist at Sunnybrook Hpl., and Dr. John Patterson who is in general
medicine and is also Director of the Chest Unit at Christie St., and at Sunnybrook.
Miss Johnston, as chairman, threw out the following question - "What does the doctor
expect of the medical social worker? What cases does the doctor refer to the medical
social worker? What does he think does not belong to the medical social worker.?"
Dr. Bailey started out the discussion on "What to expect of the medical social
worker" by stating that she must consider herself a part of the team. The medical
social worker can go out to find out something about the patient as a person. She
should never work on her own. Dr. Patterson started out with the  statement that the
medical social worker is to do the work the doctor Is incapable of doing. There are
many cases in which he cannot get to the bottom of it all. The doctor who does not try . ,
to find out all he can about the patient is not doing his job. In general medicine not
all cases need to be seen by the medical social worker. It is not the job of the
medical social worker to explain treatment. That is the job of the doctor. If, for
example, a patient has been told about thoracoplasty and he still is uneasy about it,
the medical social worker should tell the doctor about this uncertainty on the part of
the patient, and the doctor could then follow up his explanation.
There followed some discussion about a summary of the medical social workers
findings. Dr. Bailey felt that all the information which the social worker put down in
writing should be included in the doctor's folder. Dr. Patterson,on the other hand,
felt there should be a summary. He stated that doctors would not read any long
discourse.
The definition of a specialist was given as "A person who knows more and more
about less and less, until he knows everything about nothing."
It was necessary to leave before this panel was completed. The institute was
a very great success and I believe has laid the foundation for a better understanding
of the medical social worker and her function in the hospital and in the health field.
This foundation of better understanding must be followed in some active way. Perhaps
at some future date we might have something in a Canadian Nurses Association workshop onj
the relationships between the medical social worker and the nurse. The time would soon
seem ripe to bring this up for discussion at least*
July 11th. 1948
Prince Edward Island
Following the meeting of the Canadian Nurses* Association in Sackville,
June 28 to July 1, motored to Prince Edward Island on July 2nd, taking with me the
three nurses ffrom Toronto, Miss Wallace, Miss Fair and Miss Sneddon and also Miss
Wright from British Columbia and Mrs. Bennett, Chief Nursing Officer, Ministry of
Labour, Great Britain. We arrived at Charlottetown at lunch time. After lunch took
the three Toronto nurses to Cavendish. Frieda dnd Miss Edda MacDonald who conducted
the Workshop, School of Nursing of the Future, came along for the ride. It was a very
wet day and the roads were muddy. Had a lot of fun coming home. That evening I     at
attended a short meeting of the Executive Officers of the C.N.A. The officers who were
with the Executive last year all were very tired. The meetings in Sackville were grand 1
but must have been very hard work for those who were responsible* On Saturday, July
3rd, we had an all day Executive meeting at which the committees, the chairmen and
members for the coming Biennium were appointed. Following the meeting in the afternoon,
there was a tea* Government House which I attended for a very short tine, and then spen
the rest of the day with my relatives. Sunday was devoted to social activities,
beginning with a luncheon at Dalvay on the north shore. The executive were the guests
of the provincial government on this occasion. After luncheon at Dalvay we motored
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to Stanley Bridge to the home of Chief Justice Thane Campbell. I have never passed
through more beattiful scenery nor have I seen a summer home in a more picturesque
setting than at Stanley Bridge. All in all, it was a very delightful day. Prescott and
Frieda came along. On Monday, July 5th, I was to see Miss Mona Wilson of the P.E.I.
Health Department. However, she called me to say that it would not be as convenient a
time as the following morning. Saw her on Tuesday and arranged to see the nurses as a
group at the  first convenient time, as it was necessary for me to go to Halifax on
Tuesday and return Wednesday. I saw the nurses on Thursday morning. Miss Wilson had
told ae there were eight nurses, however, only four were there - Miss Wilson, Miss Ross,
Miss Beer, Miss Cox and Miss Wheeler. Miss Wilson had neglected to ask Miss Tate. I
explained the survey and asked if they would complete the Job Analysis Questionnaires
and the School Nursing Service Questionnaires. It seemdd very difficult to arrange with
Miss Wilson a time when it would be convenient to come back. Saw Dr. Keeping on Saturday
and he seemed about as indefinite as Miss Wilson.  Decided that the best thing to do would be to come when it best suits Dr. Baillie and myself. As immunization clinics will be
going on until the end of July, and as nurses are going on holidays the first of August,
one time would seem to be about as good as another. Dr. Shaw has been conferring with
the Minister of Health and Welfare in relation to accommission to be set up for the
provincial survey initiated by the Federal government* Told him that I thought nursing
should be represented on that committee. He had not planned on that. However, other
nurses approached him and it seems that now it is most likely that a panel of names will
be submitted and from that panel one name will be selected to be the nursing representative on whatever committee carries on the survey* Drove to Halifax on Sunday, bringing
with me Mrs. Creighton and Mrs. Hamilton and Carol who had returned to Charlottetown with
me on Wednesday*
Went with Dr. Baillie in the morning to see Dr. Morton. At 2.30 p.m. met with
the Provincial Consultant Committee in the offices of the Provincial Department of
Health. Dr. Robertson was in the chair. Present - Miss Shore, V.O.N,, Miss MacKenzie,
Prov. Health Dept., Dr. Morton, Dr. Simms, Dr. Bent, Dr. Laurie, Dr. Baillie and myself.
Dr. Baillie started by explaining the background and the purpose of the Study
and the desired results. Discussion then centered around the major public health problems
in the province. It was stated that tuberculosis was the first problem and that probably
75% of the time in the field was spent on tuberculosis. Apparently the average private
practitioner reports cases of T.B, and then proceeds to forget about it. This apparently
is quite acceptable to hin and the Health Dept. likes to take charge of the case. V.D.
was given as a second major problem, chiefly because personnel are not trained. There
seems to be quite a feeling of lack of training in this field. Public Health men felt
that they should be able to give advice through the private practitioner and that the
latter is now seeking this advice in V.D., the same as he has done in the past with T.B.
The third problem - infectious diseases, - it was felt very definitely that
the public health doctor is not trained in infectious diseases nor venereal disease nor
tuberculosis. It seems that ln Nova Scotia one of the requirements of the appointment
of divisional medical health officers is that he has had some experience in a Sanatorium.
Preventive Mental Hygiene was mmntioned as a fourth prblem, and plans are now
under way to build up this service. A provincial psychiatrist has been appointed and
there will be two other psychiatrists and psychologists. The details of the program
have not yet been worked out. I asked what part the nurses would have and as yet that
has not been discussed. I expressed the opinion that it would be too bad to take this
program away from the nurses, that they should be the ones to do the follow-up in the
home. There seemed to be agreement on this point. In fact, most of those present were
whole-heartedly in favour of the generalized program. Dr. Robertson rather favours the
idea of specialists in venereal disease work but neither Dr. Simms nor Dr. Bent seemed
to agree with this. Miss MacKenzie hardly ever expressed an opinion. Dr. Robertson „, jl
 -34-
ftt 1*1  ^S!it*Sirr^hi8*?ta5 ^at ** th0,,ght P°ssil>^ ^ey could train their own
nurses without them taking the University public health course. Later on, Miss Shore
S^Sl^ta^^   felt that even nurses with a public health course were not
^!q^ L      ^   r J"*?**!} WOrk- She sald ***** the n^ses are trained to do things,
but that when it comes to teaching the people they fall down. There was some discussion
of school examinations and it was stated that they were used as a stepping-stone to get
Into the home. The Provincial Dept. personnel consider that the value of such examination!
by the doctor are rather questionable. As a matter of fact, the nurses do all the examinations in the rural schools. They stated that there are more requests for school service
than for any other service. It seems that this is what has been sold to the public and
Dr. Robertson feels that we are now going to have to go out to try to unsell some of our
ideas, and that school examinations is one of these. It was stated that the health
program in the normal schools has been greatly improved. The dental-program is one for
which there is a very great need. At the present time there are two travelling dnntal
clinics, but they cannot keep these running all year because of lack of personnel. These
clinics so far, have been for school children only and children fron the ages of six to
twelve have the first choice. Dr. Baillie Introduced the question of records. It was
stated that these are kept to a minimum for the nurses. There is however, a great need
for statistical clerks. Dr. Simms said that when it comes to writing the annual report
he must sit down for three solid weeks. Apparently the doctors have to get out their
own statistical information* Maternal and pre-natal program was discussed briefly. In
only one area does the nurse carry maternity cases and that is in Baddeck. It was stated
that family doctors do not report pre-natal cases readily. This has not been encouraged
because there are not enough nurses. There does seem to be an understanding that the prenatal service is really the service which would bring the best results*
In relation to cancer, the services are pretty well localized in Halifax where
there is a cancer clinic in the Victoria General. All treatment facilities are there.
There seem* to be a very good correlation of health and welfare. Social workers operate
from Halifax. Mr. McKinnon, who is the director of child welfare, works very closely with
the Health Dept. I feel, however, from the discussion that the idea of welfare is chiefly
material relief and that possibly there is not a great deal of case work involved. It
seemed to be the general opinion that the great problem is lack of nursing personnel. It
was definitely recognized that the nurse is the basis of the public health program. The
doctors also feel that there is a great need for more public health divisional men. They
are concerned that doctors are not entering public health*
July 13th. 1948
Met with Victorian Order of Nurses at 8 a.m. Explained the survey and left the
Job Analysis forms for them to complete. Miss Shore, the nurse in charge of the V.O.N.
most co-operative. Arranged to visit some of their baby clinics. Apparently the city
does not run any, the V.O.N, operating all in Halifax. Next, went to see Miss Crosby
who is the acting supervisor for the City Health Dept. She and her nurses have an office
in the basement floor of the Dalhousie Clinic. Mr. Morton's office is in the City Hall.
Miss Crosby had not been notified that I would be coming. However, she was very nice and
I made arrangements with her to return to speak to the nurses to-morrow morning. Returned
to the Dalhousie clinic in the afternoon to observe a pre-natal clinic. This clinic is
operated in the Dalhousie clinic building with a V.O.N, nurse in charge. Mrs. Hackett
was the one in charge and as she has been away from pre-natal clinic work for a little
while she was somewhat unfamiliar with the routine. Two of the affiliating students are
assigned to the clinic. This happened to be Dr. Atlee's clinic, but he did not appear.
fhay were also one doctor short. There seemed to be a great many patients. They bring
their little blue card if they have been to the clinic before, bring in a specimen of
urine, are weighed and measured by the students and have their temperature taken by the
students and then go back to the waiting room to wait for the doctor. The V.8.N. nurse
is responsible for the administration of the clinic. She does not have any time to
conference with the mothers. This does not seem to be planned at all. She makes a
A
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U!lf ^^4^ ^z**?^8 *» a little bla<* *>ook and also notes the temperature and
weight. This is taken back to the V.O.N, office and the district nurses look over it and
if they have a patient, transfer the information to their records. The V.O.N, nurses do
all the follow-up from the pre-natal clinic. An office worker from the Salvation Army
Hospital interviews all who will be ward cases in the hospital. She copies down information from the records to a record for the hospital so that when the patient is admitted
they have all the previous clinic information. This seems to be aduplication of effort.
There should be some way by which that record could be transferred if necessary. It is
doubtful if all the information is of value or even read. At the same time a clinic was
supposed to be going on for V.D., and T.B. However, the doctors do not arrive at these
clinics until four o'clock. It seems to be pretty well taken for granted that all of
these are doctor's clinics. I do not see much evidence of nurse conferencing. It seems
that Dr. Beckwith's clinic oh Friday night is a very popular one and I was advised to
return to it.
Before lunch I had an opportunity to talk to Miss Fraser, who was a nurse in
charge of the Dalhousie clinic. She told me that this clinic is the Out-Patient Dept,
with special emphasis on public health. It acts as the Out-Patient clinic to various    ^
hospitals and takes patients from the country and province. It is part of Dalhousie
University. There are three public health nurses on the staff. One of these nurses has
had a course in supervision. I do not think that Miss Firaser herself has had any public
health training. Before the City Health Dept. was organized these nurses and the V.O.N.
did most of the visiting done in the city. They still follow a number of cases but these ■
are for the purpose of teaching the student nurses who are affiliating. They have
affiliates from the Hospital Infirmary and the Children's Hospital. I believe also, that
medical students go out into the homes visiting with the nurse. The student nurses come
for two months, get their out-patient training and visit all the outside organisations
and are taken to visit selected cases. They also go with the psychiatric social worker
attached to Dr. Jones' department. They also make some visits on their own. They are
usually pretty well through their third year in nursing before they take this affiliation,
although they have some earlier. Not all students from these hospitals are taken. Up to
tha present time, the Victoria General has not had any affiliation. One of the public
health nurses is always present at the child welfare and pediatric clinic, at the chest
clinic and at the V.D. clinic and they fill in at all the other clinics when necessary.
Cases coming to these clinics are referred to the City Department except those which are
kept for student visiting. Also saw Miss Watson for a few moments. She is a social
investigator for V.D. Cases and works directly under Dr. Morton. Dr. Morton stated that
he did most of the V.D. work himself. Miss Watson has not had public health or social
work training. It seems that all the V.D. work is done by Miss Watson and Dr. Morton.
The public health nurses apparently do not carry any cases* Will find out more about this
when I visit with them. At four o'clock went to see Miss Watson, RegistrarvQf the Registered Nurses Association of Nova Scotia. She said there was a great need for instructors
in hospitals. They have no nurse inspector of hospitals in Nova Scotia. Miss Watson was
a private duty nurse who, following her work in private duty had seven years in an office.
After the war she went back again to private duty and then was appointed as Registrar,
She has had a good background for the routine work but I doubt that her understanding of tl
educational policy is very great.
July 14. 1948
Met with the nurses of the Health Department. Ten are on duty, one nurse came
back from her vacation to the meeting. She had heard that I was going to be there and
was extremely interested. Very few of these nurses have public health training but all
seam very interested in the survey and did not make any objections to completing the
forms. They asked many questions and like all groups, seemed very happy to have someone
from outside come and discuss their problems with them. Have arranged to go out with two
of them to-morrow. Following the meeting with the nurses interviewed Miss Crosby to
complete the key forms. Miss Crosby is only the acting supervisor. Dr. Morton is
planning to appoint someone slse and is thinking of Miss Burgess. Miss Crosby apparent*:
iy
k
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does not want to continue and probably is not th« nova™ +„,!.. .  .  ,    . .
great deal of push. P6™011 *° do 8° as she do93 not |jjR a
Went to see Miss MacKenzie at the Provincial Department at noon. There are six '
!SwS mHi  departl,e^J -*? Breton »lth Miss MacDonald as supervisor and thirteen of
staff. Bridgewater, which includes the counties of Lunenberg and Queens, with three staff
nurses, one of whom is senior. Yarmouth, which includes Yarmouth, Shelbourne and Digby
counties, three staff nurses and a fourth, will go on duty in August. Windsor which
includes the counties of Anapolls, King, Hants and Colchester and has three staff nurses.
Northumberland which includes Picton, Guysborough, Antigonish, Cumberland and part of
Colchester county. They have eight nurses. Miss McCann is the senior and will probably
be appointed as supervisor. Colchester county is going to be taken out of the Northumberland unit and also out of the Windsor Unit. As it stands now, each unit has a part of
Colchester county. The sixth unit is the Atlantic which is Halifax county and has one
staff nurse. In addition to these, (see list of complete staff), there are three nurses
who are clinic service only. Two on the dental clinic and one on the mobile x-ray. These
nurses have not had public health training. They will take on nurses without public health^
training on condition that they take the course after one year's service. It is their
hope to have a supervisor in all the Units, but to date, it has not been possible to do
this. When a new nurse comes on she is brought into the central office for a few days,
then if she has not had public health, is assigned with another nurse. Miss MacKenzie
does not feel that a new nurse without public health should be given a district of her own.
I am not sure that this policy is always carried out. If she has had public health she
will spend a little time with another nurse either in the other nurses* district or in her
own district. It does not seem that they have very many group conferences, apparently the
whole staff were in last May and they do try to have a meeting like this once a year, I
doubt very much that very much is done in nursing* They have no manual. Each nurse has
a guide. Asked Miss MacKenzie for this and hope it will be forthcoming. Miss MacKenzie
stated that the expense accounts and weekly reports are sent to the central office. She
goes over these. In the afternoon went to a V.O.N. Well-baby clinic at 139 Yonge Street.
This is a room upstairs in a building. Outside there is a notice stating - "V.O.N. Well  '
Baby Clinic, Weighing and Immunization." The clinic Is held Mondays and Wednesdays with
the Immunisation Clinic on Mondays. There happened to be no babies while I was there.
Some times the attendance is two and sometimes as high as forty. I would judge that the
average would be around ten to fifteen. They do not have a regular appointment system.
Miss Tanner was the V.O.N, nurse in charge, has not had public health but is taking it
next year. If the baby needs follow-iqp in the home, the V.O.N, nurse will do it. Miss
tanner stated - "The city nurses just go in for immunization and the like, they do not
give advice regarding feeding," She has a Red Cross Worker who pulls the records and makes
out the new histories. The nurse weighs the babies and apparently does some of the conferencing. The records show that the same type of conferences as had been observed previously. Discussion of diet, weight, etc. The nurse makes a list of the attendance each day
and takes that back to the V.O.N, office. Nurses look over it and if the mother is in
their district they will make a note of this on their records. They have the Federal
department literature and insurance company literature, etc. The records are not taken
out of the clinic. A mild dicision so far would lead one to believe that there must be
considerable over lapping in V.O.N, and city. Will try to find out nore about this when
I go out with the respective nurses.
July 15th. 1948 - 10 a.m. went visiting with Mrs. MacDonald, Department of Health Nurse.
She took me to one of her schools, St. Joseph's. This is divided into the girl's school
with an enrollment of approximately 500$ the boy's school with an enrollment of approximately 500. Apparently most of the schools go from Grade 1 to 9. This Includes both elementary and Junior Hifeh. Mrs. MacDonald's health service room was upstairs. It was quite a
large room and was apparently one of the few who has a room of adequate size. Mrs.
MacDonald went over some of the duties and the records which have to be completed. There
is usually a dental survey in the fall done by a dentist ln the Grades 1 and 2. The nurses
are^esponsible for the follow-up records and making the dental appointments. The doctor :
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2fi^^SS2S«?      r™* ■duty *°weighand ■easure' c^«k teeth> *>»s±i*
S?+*^ *L™H ^<*•■ ««Pt •yms. Mrs. MacDonald does not test hearing, she feels tt
that she cannot do this adequately. Mrs. MacDonald does all these tests at one time. Th.
doctor follow with a complete examination* For all grades in between 1 and 7, the nurse
^^ ««/^«itP£Ttly Mrs# MacDonald i» able to weigh and measure all her
children and test all their eyes. In the afternoon I was with Miss Hopkins. She said it
was not possible for her to do all this. In relation to communicable disease, the nurse
must visit everyjsase. She completes the pink special investigation card and sends it to
the office with the daily report. She must then make a return visit to release the child
for school. In doing this she gives a card with a statement on the babk that the child
is free to return to school. If the case is suspected scarlet fever, the nurse takes a
throat swab. The sanitary inspector will placard after the diagnosis has been confirmed.
He gives no instructions. He removes the placard but the nurse must visit first for
release. These two visits which are essential for all cases of communicable disease,
give the nurse a very great deal of work, and when chiokenpox, mumps and measles are
prevalent,that is practically all she has time for. She must also make these visits for •
German measles. In relation to immunizations, these are done in the schools. There seems
to be many slips which have to be sent home. The parents are getting very tired of this
because there are slips from the teachers. It is their policy also to do a booster dose
every year. In relation to mental hygiene - if there is a behaviour problem, refer first
to the school doctor, then talk to the parents. If the child is to be referred to the
clinic the nurse uses the referral form to the family physician and also she may write
out an extra history. There is no special form for this. The child is examined and no
report is sent from the clinic unless the nurse goes to the social worker in the office*
The social worker follows into the heme. The nurse is not allowed to read the chart*
Mrs. MacDonald had three such cases and she never knows if they are under care unless
she phones. In relation to tuberculosis, the nurse does the patch test on the children
and contacts in the home. It seems that the work is chiefly contact work. Post sanatorium cases are followed. The nurse has one clinic day for her appointments. She is given
a typed list of the cases by the stenographer. The nurse makes out the appointment Slips,
and mails.
In relation to case loads. The school cases are, of course, the most numerous.
Family folders are kept for tuberculosis cases. No family folders are kept for infants
apparently. The nurses receive a list of birth registrations when the baby is six months
eld and she visits regarding immunizations. Pre-natal cases are referred to V.O.N. The
immunization visit has a special card, in three parts* (See sample). After the six
months visit, if the middle card has hot been returned to the health office, signiflying
that the immunization has been done by family physician or the clinic, the nurse visits
at one year, otherwise there is no further visit. Tjere are no other records on infants
or pre-school children. Following our visit to the school, went on one home visit with
Mrs. MacDonald. This was a visit In relation to an eye defect. There were other childret
in the household and these were also included, mostly ln relation to eyes and immunization since this seemed to be the outstanding problem. Mrs. MacDonald is a very vivacious
young nurse, she trained at the Victoria General and has worked with the V.O.N. She
intended taking her public health course but married. I doubt that this visit could have
been better done by anyone trained in public health. Our next visit was an immunization
visit. The mother was not at home. A third visit the same.
In the afternoon went with Uss Hopkins who is a public health nurse, to see twc
of her schools. Her health service roons are very small and one of them especially, very
inadequate. She seems a little more selective in the work which she does. Did not do
any visiting with Miss Hopkins, as we wanted to go to AfTieville, which is the section in
which the lower class of negro lives, and is away out on Thetford Basin. Dr. Baillie,
Miss Hopkins and I, went over very rough road at the end of Barrington Street. Our
purpose in going was because an immunzation clinic was being held out there. When we
arrived, Dr? Rice, the two nurses, were waiting outside the school. The janitress who
had the key, had decided to go to town and noe one could ©ft in. As it was a very fine,  ,
day, the material was just set out on a rock in front of the school and one by one six
 I-    .   , I
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about half a dozen children arrived. There were supposed to have been about thirty but
it was a fine day^for s^ndng. Some adults, mostly young men of the usual listless
negro variety wandered arhound and they were also given a Schick test. A case of diphtheria had been discovered recently in this community and also a carrier. Apparently at
other immunization clinics a stenographer is taken instead of the extra nurse. The
stenographer makes out the records and gives the slip necessary. Why it was necessary
to have an extra nurse here, even if the thirty had turned up, we failed to understand.
If the clinic is properly organized one nurse can handle it and certainly it seemed to
be a waste of medical personnel. In cases like this it seems to me that the nurse should
be able to give the immunization. As Dr. Baillie says, why cannot a standing order be
made which will cover it and why all this fuss about legal responsibility. After the
clinic, Dr. Baillie and I went to the Provincial department to see Dr. Marshall who is
head of the new Neuro-psyehlatric Division. Dr. Marshall has two psychiatrists appointed
and is appointing a psychologist. The idea in relation to mental hygiene is that these  |
two psychologists will be stationed in separate parts of the province and it will be the
beginning of a travelling clinic. The purpose of the travelling clinic will be - 1. to
supervise the patients in county hospitals, (see note following). 2. to act as consultant
to doctors in the community. 3. the psychologist will work with the Department of Education in regard to school children, 4, the clinic will probably give preventive shock
therapy,
Dr, Marshall explained that Nova Scotia is the only province which does not
take complete care of its mental patients. There is a mental hospital, the Nova Scotia
hospital at Dartmouth, but each county has a county hospital which looks after those who
are not violent. In relation to the feeble minded and retarded children, there is a
school at Truro, Halifax is the only centre which has special classes for children in
school. Dr, Marshall is not at all satisfied with the way these are operated. We asked
him about teaching in the Normal Schools. Dr. Jones, the psychiatrist in Halifax is
giving a course in mental hygiene to the students at the summer school at Dalhousie.
This apparently is very popular.
July 16th. 1948 - Went out with Miss Cameron, a very shy young V.O.N, nurse. She has not
had her public health training. Our firfet visit was to the home of a Jewish mother whose
baby is two weeks old. This is the third day the nurse had been in to bath* the baby. It
was not the mother's first baby and I could not quite see the necessity for Miss Cameron
going in on this day, even though it was to be a paying visit. Miss Cameron explained
that their routine is to return once a week to weigh the baby until it is six weeks old.
Then once a month until a year old and then the baby is discharged. The mother is discharged at six weeks. Our second visit was to a three day post-par turn mother and her
baby. I did not stay for the whole of this visit. Miss Cameron is a pleasant nurse and
gave good nursing care, although there were some points in the technique of bathing the
baby which I felt might be criticised. No doubt the method she used is the one she
learned in hospital. In the afternoon I went with Miss Tanner, nurse with whom I had
talked at the Baby Clinic for which no children had arrived. Apparently after I left
that day, six monhers did come. Miss Tanner expects to take piiblic health this fall.
She is a very bright young nurse and is apparently very popular with her patients. Our
first visit was to a home to see if the mother had returned from hospital. Found that
she had been back for two weeks. Seems to be a lack of reporting here. The mother was
feeding her baby when we went in. "Miss Tanner weighed the baby and discussed the baby's
formula and getting the baby out In the sunshine, also asked about the mother returning
herself. Second visit was to a six week's old baby. Mother is moving. This mother had
been very timid about handling the baby. Nurse said she would come back before she moved
to Ontario at the end of this month. Third baby was for the purpose of making the one
year visit. Baby was in a crib outside, the mother was very young and perhpas at times
a flighty person. She discussed the general health of the baby and then said "I won't
be back agan, I am dismissing the bab*". Seemed rather an abrupt word to use in front
of the mother. Fourth visit was just a stop on the street to see Mrs. MacDonald who was
sitting on her doorstep. She is a Spychiatric case who has had shock treatment and
 -39-
is now going in for insulin shock therapy. She has a young baby who apparently is
already boarded out. Miss Tanner's attitude to the patient was a very excellent one.
Fifth visit - not at home*
After this went to see the baby clinic on Brunswick Street. The baby clinic is,
operated in one room by the V.O.N, and next door in a larger room, the city nurses and
the doctors come for the immunization clinic. The doctor is supposed to arrive at 3.36* '
The nurses arrived shortly after 3 p.m. Already the room was full of mothers and very
young children. The majority of these, oerhaps I should not say the majority, many of
these had gone in to the V.O.N, nurse where actually the chief service is a weighing one.
The V.O.N. had a St. John Ambulance volunteer who pulls the records. The nurse weighs ji
the babty and as the mother is sitting dressing the baby she may talk to the mother if
there are not others waiting for weighing. There were some notes on the records, which
I expect the nurse writes after she has talked with the mothers, applicable to the clinic.
The immunization clinic was very poor psychologically. The nurses were attempting to
see those that had been vaccinated and read the vaccination results and give the certificates before the doctor came. They finished this quite a long time and were standing
around with nothing to do. When the doctor came there was also a stenographer with him
who pulled the records if the mother had been there before, if not, made out the card and
after the vaccination was given, gave the slip for the return the next dayv It seems to
ae there could be a card made out which could be given to the mother and which would
obviate the necessity of giving these slips each time. Case of administrative detail
again. The doctor sat at a table in front of the room in view of all and gave the
immunisations and most of the children howled. One public health nurse, she happened
not to have had public health training, but was on the city department, filled syringsj
her technique was questionable. However, this was the technique permitted by the doctor.
She refilled the syringes without taking clean ones. The other public health nurse, she
was public health trained, brought the patients up to the doctor and saw thsat the
patients waiting kept in line, and those who came later did not get in ahead. Some job
for a public health nurse I After visiting with Miss Tanner in the morning I returned to
Miss Shore's office and completed the key form with her. At 4 o'clock, after the baby
clinic, I returned to discuss students program, etc., with Miss Shore. They seemed to
be going in the right direction, but there is not nearly the same understanding of
student programs I think, as there is in Hamilton with Miss Rsss and Miss Sneddon. I
discussed the matter of overlapping with the city and they readily recognized this and
felt that perhaps they should drop the six months and one year visit. I said I did not I
feel that it was a matter of any one agency dropping anything necessarily. It was a
case of clearing and getting together and discussing who was going to do the particular
thing, I could not see why both the V.O.N, and the city nurse, who apparently only goes
in at six months for immunization, should go in. If the city so desired, whyc ould they
not delegate the responsibility to the V.O.N, nurse for the particular cases which she
is visiting. In relation to the visit at one year, this is the tine when they pick up
a great many pre-natal cases. However, there is no reason why the city nurse when
making her visit at one year, should not pick these up. As present policy stands, the
city nurse does not visit at one year unless they have been delinquent in getting the
immunisation done or in sending in the card*
In the evening, Dr. Baillie and I went to the Dalhousie clinic to observe the
T.B. and V.D. clinic which are held there on Friday evening. The clinic has «a very
nice set-up. Dr. Beckwith was operating the T.B. clinic. Said he would answsr Doctor
Baillie privately when Dr. Baillie asked why the T.B. clinie was being heid here! Miss
Myers is In charge of these two clinics. She is a public healtfr nurse who has taken a
supervisory course. From the way she talks she has an understanding of better public
health practices than followed in the clinic. However, I do feel there are many areas
where she wight put them into effect, even with Miss Fraser in charge, than she seems
to be doing. She stated when I asked her, that the public health nurses do see the
patients. The patients, if they have any trouble come to them. I pointed out that this
hardly seemed to me to be enough. There is absolutely no social work. Whether or not
there is at the hospital, I do not know, but I think not. At any rate there is no
 -40- ^^
social work done to the cases who are coming to the clinic and since most of these cases
are a poorer group there must be a very great need. Dr. Gosse, who is in charge of the
V.D. clinic sees all V.D. cases who need to be seen by anyone not giving the treatment.
In other words, he does the conferencing. There seems to be some confusion as to who
does the follow-up in the V.D. It was stated that Miss Hulbert or Hubert of the Dalhousie clinic does the follow-up for the V.D. cases and yet Miss Watson, who is directly
under Dr. Morton, is the  social investigator for V.D. I do not know whether they discuss
things to gether or not, but it does seem to be a rather confused program. I do not
think it is even worth while te take the time to straighten out these points since many
of the clinics are going to be moved to the out-patient department of the V.D. as soon
as it is opened, Miss Myers stated that as far as she understood, only the paediatftic
clinic would remain. After the clinics move out Dr. Morton hppes to move into the
Dalhousie clinic and the public health clinics will be taken over by the public health
department. It is hoped that a great many of these confusing points and over lappings
will be cleared up. In relation to obtaining a supervisor, for the city department,
apparently the salary offered is $1,800 to 2,200 or $2,400. There will never be anyone
obtained who will be worth her salt at that price.
 -41-
foly 17, ffifo- Saw Miss Lawrence who. is a psychiatric social worker for the Mental
Hygiene clinic. Dr. Jones is the doctor. Talked with her at coffee. She says they
are very short of staff, but the plan is that the social workers do the follow-up from
the clinic. If a school child has been referred in by the nurse, the psychiatric social
worker visits the school to see the teacher and usually tries to make a home visit. A
report is sent by Dr. Jones to the agency and if there is follow-up work to be done in th
home, this does not seem to be transferred to the public health nurse. Following my
talk with Miss Lawrence, went to see the new Victoria General Hospital. Was shown
through by Miss Millar, Superintendent of nurses. Miss Millar is also president of
R.N.A. of Nova Scotia, It is a very lovely new hospital.. She has about 67 graduate
nurses and 135 students. They are very short of staff and it is very evident that
student nurses are being used to staff the hospital. Did notsaee the teaching department
as it is apparently in the  nurse's home.
Saturday afternoon, went to Peggy's Cove, great piles of rocks and desolation
but all the same, rather attractive.
July 19. 194B. - Met with the V.O.N, nurses in the morning and wBnt over the individual
job analysis forms. Completed my work with the V.O.N, in the afternoon. The remainder
of the morning saw the nurses with the City Health Department. They all seemed to
enjoy my visit and contributed some very good ideas. Saw Dr. Grant, Dean of Medicine,
Dalhousie, in the afternoon*
Tuesday. July 20. 1948. - started for Pictou. On the way stopped in Truro where we
interviewed Dr. Davis, principal of the Normal School and Miss Reid, the nurse in the
Normal School. Miss Redd showed us "Uie Health Education curriculum for the school.
It is very factual and I am afraid she tries to give the Normal school students too
much of the factual material and not enough of the practical. There is not any linkup with the Truro school nurses when they are doing their practice teaching. Miss Reid
seems very sincere and is no doubt, doing very good work within her own limits and the
limits of the curriculum. The mobile x-ray unit was set up in the adjacent school yaad.
Visited the nurse and the technicians working on it. Drove throug the Stewiacke valley
which was very beautiful. Arrived in Pictou about 7 p.m. at the Braeside Inn.
 -42-
NORTHUMBERLAND HEALTH UNIT
OH 5f c?48 "n!6^ *° ihQ  °ffice °f the Northumberland Health Unit. Had a meeting
with Dr. Sims, Dr. Lavers, Miss McCann, who had returned from her holidays for my visit,
and three of the staff^nurses. After meeting together I talked with the nurses separately. I thought the best approach here would be to get their problems and find out
from them all how they did their work. The group present consisted of -
1, Miss McCann, who is to be the supervisor and is acting now in the capacity of senior
nurse; she, however, carries a very heavy case load. She has West Pictou and it has a
population of. 20,000, she also has North Colchester.  Her towns are Pictou, Westville
and TStamagouch. She has 67 schools in West Pictou and 29 in North Colchester.
2. Miss Gray, who has East Pictou, the towns consisting of Stellarton, New Glasgow and
Trenton. She has 70 rural schools and three or four town schools. Miss Gray is a
veteran of the first world war and has not had a public health course. Her total population is 25,000,
3. Miss Munro, who has West Cumberland, population of 20,000.
Parsboro. She has 28 schools.
Her towns are Amherst,
4. Miss McGarry who has only been on since March and is getting some experience prior
to taking her course at Toronto this fall. She does not have any assigned district
but works with Miss McCann.
The chief problem centres around the fact that they each have such an extended
territory and the follow-up visiting is very difficult, if not impossible. It does not
seem that the winter holds them up too much because they can then concentrate on their
town work if the roads are impassable. In addition to these nurses Pictou has two V.O.N,
nurses. Glasgow has two V.O.N, nurses, Amherst has two V.O.N, nurses and Canso has one
V.O.N. There is also a school nurse employed by the towns of New Glasgow, Amherst and
Truro. However, Truro is in South Colchester and is not in the Northumberland Health
Unit. Miss Munro says that Parsboro has a nurse employed on a part-time basis to look
at the heads, communicable diseases, etc. It is much harder for her than if there were
no nurse. As a rule the public health nurse works with the local school nurse and the
V.O.N, in the immunization program but not to any other extent. Tuberculosis seems to th
major problem. The nurses did not seem agreed as to whether it or the school work took
the major part of their time. There is a great shortage of sanatorium beds. Sometimes
the waiting period is three months, in which time the nurse supervises the home and
visits as frequently as is possible. Apart from the home supervision of the case, the
nurse is responsible for the patch test of all the family contacts. She must return in
four or five days after giving the patch test to read it. She does not encourage them
to go to the family doctor to have it read as it is very difficult usually, for them to
get to the  doctor. However, I think that some thought could be given to this in some
cases. If there are open cases they are requested to get sputum tests about three times j
a year. In relation to x-ray appointments, the family doctor informs the patient of
the next x-ray day or in some areas, where the  clinic is set up, may be told by the nurs
All contacts and indigents come to the clinic free of charge. The others go to the
hospital for their follow-up x-ray and they are expected to pay for this.
Child Welfare - pre-natal, - there is no organized program. They do it incidentally
with their other program. No records are kept of pre-natals. Infants and pres-echool
birth lists are sent from the hospitals at the end of each month, except to Miss Gray's d|
district, and she goes to the hospital and copies the list. No doubt, however, she could|
arrange to have it sent, but prefers to do it this way. From this list the nurse makes
out the school card. This could be done by a stenographer, but is not. The card is
filed in the office. When the baby is six months old a letter is sent to the mother from|
Dr. Sims stating it is now time for immunization. (See copy of letter in folder.)
Between the ninth and the twelfth month the nurse visits the home. This is called the 1:
 -43-
pre-school visit. She then marks up the card recording the immunizations. This is the
only record for the pre-school and infant program. The Health Dept. nurses do not hold
any baby clinics, the following are held by the V.O.N., - New Glasgow, every Friday with
an immunization clinic once a month; Pictou, two times a month, with an immunization
elinic in the fall; Amherst, every week, an immunization clinic in the fall and in the
spring. There is no doctor present at any of these clinics. The routine seems to be
that one of the nurses will weigh and measure and the other may conference. They do not
seem to use volunteers. In relation to booster doses for immunization, three to six
months after the third dose, a booster is given. Some doctors will give a return date
for this. During the visit the nurse tells the mother about it. The second booster
dose is given the first school year or before. No record is kept for incidental health
problems.
School - The V.O.N, nurse carries on the school work at Pictou and Canso. The nurses
try to visit the schools once a year but this is not always possible. For example, Miss
McCann and Miss Munro have not completely covered their district in the past two years,
fhey try first to find the area with the greatest need. They have an opportunity to do
this because at the beginning of each school year they make a quick visit to each school,
really in regard to immunization. Then they choose a centre for the fall immunization
clinics. From then on the work is left with the teacher to organize. She arranges with
the doctor and arranges the day. When it is all ready the nurse will come and help. The
teacher also arranges the publicity and in each school the teacher gets the consent slip
signed. For example, last year in Tatamagouch there was one clinic which took in the
29 school^, of North Colchester. Apparently the doctor is very enthusiastic and he took
a major part in the arrangements. The nurses also do patch testing in the high schools
in gr«ufe9 and the negatives in grade 11, and all new pupils. This is done at the
beginning of each school year. If they are positive an x-ray is arranged.
The doctors do not do any work in the schools. The following is typical of
■Idle yearly visit of the nurse to the school. She will probably spend one-half day there.
This would be the routine of the visit.
1. Weigh and measure the children. She takes the scales with her,
2. Test the eyes with Snellen chart.
3. Examine head, general condition, teeth, hearing, etc,
4. Complete the record which stays in the school.
5. Conference with the teachers,
6. Copy the names with defects on the sheet.
7. Make out defects list. (This is done in triplicate, one goes to the parents, one to
the family doctor and one is kept by the nurse, this latter is taken to the office
and filed.)
8. Inspects sanitary facilities and if necessary, makes notes to report to the sanitary
inspector.
9. Conference with teacher. These points are not necessarily in the order completed.
Any of the major defects such as eyes, orthopaedic, malnutrition, etc., the
nurse attempts to follow up with a home visit. Card is made out for all new children
by the nurse. Any information which she cannot get on that visit will be obtained from
the parents by the teacher and the card will be completed. Sometimes the teacher helps
with the records, weighing, etc. The nurses try to get the teachers to start school
lunch programs and have been quite successful in some areas, in others, not. The nurses
feel that a great deal of factual information on health is taught to the children and
not nearly enough from the practical aspect.
Communicable Disease Control - The M.O.H. for the area is responsible. The teacher will
call him if she has any suspicions. Some times the nurse may be called. The teacher is
responsible for contacts.
 -44-
genereal Disease - This Division was a specialized service until about two years ago when
It It3  JSw^    h! fneralized Program. Each card has a case on file in the office.
Every month the nurse takes each card, goes over them with the private doctor. He gives
her the up-to-date information on treatment, etc., for his cases. If a case is delinquent, the doctor will report the case and the nurse will visit and try to get him for
further treatment.
Tuberculosis Control - In relation to the T.B. work there seems to be a great deal of
recording. (Copies of records kept in separate folder). In relation to the daily and
weekly reports which the nurse makes, there seems to be a lot of duplication. Miss
McCann says that it takes nearly all of Saturday morning to do the weekly report.
Tuberculosis record - clinic form I contains the data on the patient. The nurse copies
information from this into the black loose-leaf book which she carries. This is the only
place in which home visits are recorded.
At the meeting in the morning gave the nurses the individual Job-Analysis form
to complete and asked Miss McCann to send this in in a couple of weeks. In the afternoon
visited the V.O.N. There are two nurses, Miss McKeracher, who is away on holidays and
Miss Shaw who has been with the Order for a year and a ahalf. She has not yet taken the
public health course. The V.O.N, has Pictou town. They have two clinics each of which
is held once a month. At one clinic the attendance is from 15 to 15, at the other 25 to
30. There is no doctor in attendance. They take babies from two months to one year.
One nurse weighs and measures and the other conferences with the mothers. Sometimes
there is a volunteer. This seem generally to be in the summer time when one nurse if off,
In the winter time the two nurses work by themselves. In the fall an immunization clinic
is held and the health department nurse assists. The school work is just regular routine.
No report is sent to the Health Officer. Asked Miss Shaw if she would send me through
Miss McCann, a copy of the 1947 report. Had dinner at Pictou Lodge with Dr. Lavers and It
Miss McCann, after which we went to the home of Dr, Sims, Had a very nice evening. They
told us stories of their experiences in Nova Scotia, Many of them were very amusing.
One which seemed to give them a great deal of amusement was a letter which was received
from a mother following patch testing of the family - it is unusual for the nurse to
ask that the report be sent in by letter, but because of transportation difficulties it
was done in this case. This was the letter - "Dear Friend, This is to tell you about
the patch test which you gave us. There is nothing on any of us except Rupert, who was
red at both ends. That is all. No lumps, no bumps."
July 22. 1948. 9 a.m. - Started on a two day trip to Antigonish and Guysboro County with
Dr. Sims and Miss McCann. We arVived at Aberdeen Hospital shortly after 10 a.m.
Dr. Baillie and Dr. Sims saw the M.O.H. Miss McCann and I talked with Miss Mary Ross
who is the Superintendent of nurses there. Miss Ross trained at the Aberdeen Hospital
and has had no further qualifications for the position she now holds. Miss Rhoda
MacDonald has been the Director of Nursing but has recently resigned. Miss Saunders who
has been her assistant has recently been appointed. She also was trained at Aberdeen and
has had no further qualification. I should think that the nursing situation looks
rather grim. Miss Ross lacks push and does not seem to have very much comprehension abou
nursing education, neither has Miss Saunders. They have a school of nursing and have
around 60 students. Miss Ross says they are taking in fewer this term. The Board has
an idea that students are costing them too much and therefore, they are reducing the
number. They will soon learn that the students have saved them a lot of money and that P
the graduate nurses that they will have to substitute will cost them a lot more. Plans
are under way for a new hospital. Nurses are certainly needed in key positions in
Nova Scotia.
From Aberdeen Hospital we drove through Stellarton and saw what is known as
Red Row there. The thomes of tha miners. From Stellarton we drove through very nice
 -45-
ITfZ T±JEtigl?t+ WueVtJe.  had diDner at Betha^ House> *** is the Mother House
£+v^ r^t r%f 2!: MaTtha*s- M°ther Ignacious is there, but did not dine with us.
w LS7, h   Extension Department of St. Xavier joined us for dinner and kept us
fascinated with his description of his philosophy of living for Canada and Canadians
and toe story-ot  the cooperative movement. After a delicious dinner we adjourned and
talked again with Mother Ignacious. We then went down to the University and saw Dr.
Codyjs set-up. He showed us some maps with pins showing all the co-operatives, the
credit unions, the wholesale houses, etc. From there we went to St. Martha's Hospital.
Miss McCann and I saw Sister Mary Calvary very briefly. It was not possible to get a
syllabus of their nursing course. Sister said that it was in print now and she would
be glad to send it to me. They have some sort of an affiliation with the University.
Sister said it was a weak affiliation. The University grants a degree; I question as
to whether or not that degree would be acceptable in other Universities in Canada, but
Sister thought that it is a University degree and that as the University is recognized
that it also would be recognized, even though apparently, two years credit is allowed
for the three years of nursing training. From the hospital we drove to Grant's Hotel
in Guysboro. Guysboro/ is a very small community but has a very beautiful situation.
We went out for a walk in the evening and later on met Miss Morrison who is the nurse
for Guysboro County. With her we want away out into the country to see a scarlet fever
case. There is one doctor in Guysboro and as he was away on his holidays, Miss Morrison
seems to be called in a great deal. The doctor puts a lot of responsibility on feer.
There is a Red Cross Outpost Hospital but no patient can be admitted without doctor's
orders and when the doctor is away, Miss Morrison has to see the patient before they
will admit.
July 23. 1948.- Breakfast early so that some fishing could be taken in before our trip
to Guysboro County. No luck at fishing. We drove on from Guysboro to Canso, taking
the route along the coast. Canso is a very bleak and barren fishing community.
Co-operatives are active/ there and this has, to some extent, improved the lot of the
people. Apparently you belong to one of three social classes according to where you
live. You may live "up on the hill" which is a community known as Hazelhill; you may
live "down over the hill" in Canso or you may live "on the Tittle". The Tittle being
their way of referring to the area along the strip of water known as the "Tickle". The
rocks crop out everywhere' and make it very difficult to raise any crops whatever. There
were a few gardens but these were rather poor. Miss Morrison who accompanied us on
this trip took me into a home. There was a month old baby. The V.O.N, nurse had been
in attendance but for some reason when the baby was ill Dr. Stanton, who is the doctor
in this community, called in Miss Morrison. This was her second visit and apparently
the baby was better. The home was very poor and very dirty. There were five children,
all the children are rather small for their age. This is characteristic of this whole
fishing village coast community. Miss Morrison says that about $0% of the homes in these
communities were like the one which she took me to.
Following a tour around the town, we went to the Red Cross Outpost Hospital
where it had been arranged that we should have lunch. This hospital was opened the
26th of May. It has ten beds. At the time it had four patients, two of them being
mothers and their two babies. The other two patients, a man with virus pneumonia and
a month old baby who had been admitted with diarrhoea; the baby was better. Dr. Stanton
talked with Dr. Sims and Dr. Baillie. He is apparently very enthusiastic and endeavoring to include some public health, will not take confinement cases unless the mothers
have been to him for pre-natal care. A large percentage of the children in the schools ?
which he visits are immunized. He has been there for ei^it years and was about ready to I
leave when the Red Cross Hospital was established. This has given him a new interest
and has made his facilities so much better. There is a V.O.N, nurse in Canso; she is
not trained in pifclic health. From what I could gather from Miss Morrison she does some
of the schools and is supposed to be responsible for bed-side care and the infant
welfare. However, there did seem to be some overlapping. I do not know the reason for
this. Perhaps the doctor does not work so well with the V.O.N, nurse.
Ad
 -46-
^  *    GT^° C2?ntar„ia divided ^ two municipalities. It has a population of
somewhat over 16,000. Miss Morrison has 90 schools with a population of 3,000 pupils. In
(ganso there are five sisters who do what is described as social work, it seems to be to
give material relief and work with unmarried mothers placing their children. There are no
other nurses in Guysboro County. From Canso we went to Dover which is a fishing community
and is bleak and barren as Canso. Then from Dover to Whitehead, Torbay, Larr^River where we
considered whether or not we should come back to Guysboro. However, Dr. Sims seemed very
anxious to show us the country so we continued on the trip going through Goldboro, Isaacs
Harbour and Country Harbour. It was all very beautiful then up through the country through
what is known as the Barrens to Melrose and down to Sherbrooke where we had dinner.
Sherbrooke is on the St. Mary's River. After dinner we went fishing. No luck again. We
drove back to Antigonish to the Royal George Hotel, through what appeared to be very beauti©
ful country, especially along Lake Lochabar. However, it was after dark and we could not
see it. Through the kindness of Dr. Sims and Miss McCann in taking us on this trip we
certainly gained an impression of the vastness of their problem or rather the problem of the
rural nurse in such a county, such as we could not have obtained in any other way. Dr. Sims
feels that there should be at least four nurses for Guysboro alone and he is planning to
build up his program to have at least one nurse for every four to five thousand people.
This is a long term project and it will be some time before it will be achieved. Miss
McCann and I had lengthy discussions about the nursing situation in Nova Scotia. She feels
very pessimistic about it, especially in relation to the training schools. She feels that
some stimulus is needed and that it will be quit^ a long time before we will be able to
get them on a truly educational basis. She has not been appointed supervisor although she
has had a great deal of experience. She taught school for nine years, took her nurses
training, then she took teaching and supervision at McGill, following which she had experience in instructing work and as assistant superintendent and superintendent of hospitals.
Then she took her public health and has been more or less acting as senior nurse in the
Northumberland Health Unit. She, "however, has a very large area of her own. When new
nurses are taken on, she is the one who is responsible for planning their work.. For some
reason her appointment as supervisor has not gowe through. Spoke- to Dr. Sims about this
on Saturday morning as we were leaving. Apparently he feels that she should go away to
Columbia for a summer term just so that he will be able to say to the other nurses that she
has had this extra qualification. I said that I felt that she had the extra qualifications
now and it would be too bad to wait for another year before making her appointment official
and allowing her to obtain the extra salary which goes with it.
July 24. 1948 - Left Antigonish about U a.m. for Baedec. Crossed the Ferry from Mulgrave
to Port Hawkesbury. It was raining so the trip was not so enjoyable. Arrived in Baedec
about 2.30 p.m. Met Miss MacDonald at the home of Dr. MafiMillan. Reservations had been
made for us at Normaway at Frizzelton which is up the Margaree Valley. We went there and
had very fine accommodation. Dr. Baillie got in some fishing Saturday evening and then
again early Sunday morning. About 11 a.m. on July 25th we left to go aground the Cabot
Trail. It was rather dull at first but when we got out jio the coast it cleared. The roads
were not too bad until we started coming donw from Ingonish then they were rather rough
and there was a lot of construction work. We arrived in Sydney about 11 p.m. and got to
our rooms in the Isle Royale Hotel.
 -47- IP
CAPE BRETON HEALTH UNIT
J^f *l  ^ "/et £f **" morning ^th Dr. MacDonald and Miss Hazel MacDonald. Their
2*4*  n! ^ « Xf ^ h°?S8 which was Purchased about three years ago for the Health
Unit. Dr, McCurdy is the doctor in charge of the Tuberculosis work in this area. After
the general meeting I met with Miss MacDonald and planned the program for the week.
The rest of the day was spent in getting information for the key forms. Cape Breton
has a population of about 150,000. The county of Cape Breton has 110,000. In this
area there are five incorporated towns within the radius of fifteen miles of Sydney.
There has been a move to make a metropolitan unit of Sydney and the area. This would
have four districts and four full time medical officers of health. It has not gone into
effect because of personnel needs. The nurses have about 350 rural schools. They are
not responsible for the following town schools which have their own school nurses.
Sydney - 1 school nurse;
Glace Bay - 2 school nurses;
New Waterford - 1 school nurese.
The following hospitals have Schools of Nursing - City Hospital, Sydney. St. Joseph's
Hospital, Glace Bay. New Waterford General. Glace Bay General. Hamilton Memorial,
Sydney.
Met with the nurses of Cape Breton County in the Health Unit office. Explained
the Survey and went over Job Analysis forms. They will all complete these and send them
in. Two of them will also do/£ the School Nursing questionnaire. Then followed a
discussion of their work.
Pre-Natal Programme - The nurses feel that they are not doing enough. The doctors do
not refer cases. They are all convinced that the public health nurse has a part to
play in pre-natal health supervision. They realize with the present set-up they cannot
do very much more. They also realize that some program is necessary to educate the
doctors to an understanding that the nurse has to play. With regard to the post-natal
program, the nurses felt that the  doctors do not do proper post-natal examinations.
Venereal Disease - This is a great problem and they do not know how to approach it.
Until quite recently it was carried by a specialized worker and now it is to be included
in the general program. They feel that more education on the part of the public and
a more understanding attitude to the subject is necessary. They, themselves, feal that
they need much more preparation and practical experience in venereal disease control
in their post-graduate work in public health nursing. They state that they have hardly
any and are just given the literature. Another difficulty is that the clinic in Sydney
is a very dark room in the city hall. There is a movement to have it transferred to
the Health Dept. building. This will make it very much more suitable and easier to
handle. There is no social service, it is"purely a treatment clinic.
Infant and Pre-School Program - They feel the need for more Well-baby conferences and
for better follow-up in the homes.
Tuberculosis - This seems to be their major program. They feel that there is a much
better understanding on the part of the public. The problem of beds for open cases
is not a great one and they have very few opeh cases in the homes. They feel that the ■
mass surveys have helped a great deal. In my visits following I noted a great change
in the attitude of the people toward tuberculosis. They were all very anxious to have Pj
x-rays.
School program - Getting the defects corrected is the biggest problem because of the
lack of facilities. There is a great lack of dental care and also the cost prevents
many from obtaining such care. Transportation costs to the centres are very great and
deter many from receiving the attention needed, I asked them if they felt they were
losing out because of the lack of physical examinations by the doctors in the schools. |
 -48-
They said. no. Cardiac is about the only thing which the nurse would not discover
and there are so few of these that it would not be worth while to have the doctor
examine all the children. We discussed the background needed by the teachers. They
felt that they needed something more practical. They stated that many of them do a very
fine job. In nutrition, we-discussed the use of consultants. We discussed the mental
health program. Nurses are all agreed that they have a major part to play and when
behaviour clinics are established they should prepare a history on the homes and that
they should also do the follow-up.
Orthopaedic program - The Red Cross had a clinic during the war but they have stopped
it now. At the present time the Rotary has a clinic and has an Orthopaedic doctor
come. The Health Department nurses assist at these clinics. Only two are held each
year. Cases are referred to the nurses for follow-up. Arrangements may be made to
go back and forth to Halifax. All these are things which the nurse has to do and are ve,
very time consuming. C.N.I.B. clinics are held and the Health Dept. nurses attend
these the Saturday that the clinic is in session. They are held at three centres.
The following is a division of
each district -
Jape Breton Unit and the number of nurses in
Cape Breton County - 8 nurses, 1 supervisor;
110,000 population
Inverness County - Miss MacDougall and part time of Miss Martell and Miss Lytle,
21,000 population.
Victoria County - Part time of Miss lytle, stationed at Baedec. Miss Jessom at
Ingonish,    6,000 population
Richmond County - Miss Martell.  11,000 population
In the afternoon went to New Waterford to be with Miss Setchell. New
Waterford has a population of about 10,000. A school population of some 2,000. There
is however, a school nurse. New Waterford is only a part of Miss Setchell's district.
She has a very nice office in the Town Hall. She keeps all her own records and has no
clerical assistance. Saw Miss Setchell's records, she has a family folder for nearly
all her T.B. cases. There are very few other records than the T.B. Inside the family
folder there are the green history sheets and also a social data sheet which is
yellow. There has not been a clear distinction between the information which is to
be put on the social data sheet and the information on the individual sheet. There is
very little real social information. The nurse copies the T.B. x-ray report onto the
record. There seems to be a lot of clerical work for her. There are a great many
social problems in connection with the tuberculosis cases in New Waterford. Miss
MacDonald stated she thought that two-thirds of the problems in relation to tuberculosis was of a social nature, I visited two cases with Miss Setchell - Mrs, Donovan,
whose husband was dead and who has five children, the last one born illegitamately.
Because of that her Mother's Allowance was cut off. Miss Setchell has been spending a
great deal of time conferring with welfare offices, etc., in an endeavour to have this '
allowance re-established. A second case, Mrs, Hincks whose husband has just been let
out of jail, where he was detained for a month because of treating his wife abusively.
There are four or five children in this home and very little money. Here too, there  ;
are a great many social problems. Miss Setchell has many such cases. One wonders how
much nursing there is in dealing with these cases. Is it not more social work? Do we I
need to consider a different type of training altogether for this community worker?
After mkking the T.B. visits we called at the New Waterford Hospital for the ;
immunization trays. I talked briefly with the superintendent, Mrs. McLaughlin. The
hospital has 70 beds, there are 30 students, 5 supervisors, 4 general duty staff nurses/
There are mo practical nurses. Ward maids are used for the housekeeping duties on the
wards, however. Miss Setchell was having her weekly immunization clinic. This was V
 -49-
held in the Legion Hall. The doctors, of whom there are five in New Waterford, take
turn about in coming to it. Usually there is an attendance of 20 to 30. They give
vaccination for smallpox and combined whooping cough and diphtheria. Scarlet fever
toxin is not given. They were taught at McGill that it is not effective. An immunization tray with sterile set-up was obtained from the hospital. Sterile towel was placed
on the table, forceps, syringes and needles in a tray. Two students from the hospital
came to assist just before the doctor arrived. No notice is given to the mothers about
when to return. They all seem to know. If they do not turn u$ at the clinic when they
are supposed to, a penny postcard is sent. Last year there were only eleven who did
not finish the complete immunization. All the cards are looked after by the nurse before
the doctor comes. This seems to be quite an efficient way of doing it. The routine
for immunization is * the  student swabs the arm, nurse holds the arm while the doctor
gives the immunization. The second student changes the needles and fills the syringe.
The Baby clinic is held in this same room twice a month. A volunteer worker assists
and the nurse interviews. She has her desk in the far corner where there is a considerable amount of privacy. The nurse can change the formula and she can also add cereals
and cod liver oil to the diet. If the mother were going to go to the doctor she probab- .«
ly would not change the formula. She tries to follow up as many cases as possible into
the homes.
New Waterford is a mining centre, dirty and smokey. Miss Setchell seems to
be a very efficient nurse. She took her course last year at McGill. Previous to that
she was In the Navy and has had ten years of operating room experience.
July 28. 1948 - Met with the V.O.N, nurses. Miss D. Armstrong in charge. Explained the
.survey and left Job Analysis forms which Miss Armstrong will send in later. Completed
the information forms. Did not arrange to do any visiting with these nurses. Miss
Armstrong is the only one who has had public health training.
Went at 11 a.m. to see Miss McPhee, the Metropolitan Life Insurance nurse in
Glace Bay, Her program seems to be pretty much the same as the V.O.N, except I would
judge the instructional work is more limited. She does not have any clinic. Hiss
McPhee has had public health nursing. She is the only Metropolitan Life Nurse outside
of Quebec. She has been eight years in Glace Bay and previous to that, she was three
years in Fort William*
In the afternoon went with Miss Buffett to her rural area. We visited the area*
aroundManidieu and Louisberg, The majority of the visits were T.B. cases. The first
one a young girl of eighteen who suspected tuberculosis and was supposed to be on rest.
Talked to her at the gate*
Second case - Mrs, O'Neill who has had tuberculosis for the last five years and is now
leading a more normal life. Her children took over the household duties and managed
very efficiently all during the time she was ill*
3* A Mrs* Bate who had had tuberculosis for about three years. She has three children.
Her sister looks after the children.
I was very surprised to find, in most of these homes, electric light and
telephones. Their standards of furnishing however, are very low. Some of the houses
were very clean but the floors might be in very poor condition and there was very little-
furniture. They seemed to be content with just essentials.
4* To a case who had recently been discharged from the Sanatorium, Three weeks before
he was discharged his wife was taken in. His mother looks after three small children.
5* An elderly woman who was arthritic. Her daughter who was formerly t^erculosis
and now there is a possibility of T.B. peritonitis. Is also deaf. Second daughter
teaches school in a nearby area. She has forty-nine pupils* . JJ
 -50-
H A!?^eL^ A*t a1*? 3^ldren» y ~ a very clean home. Nurse called because
of a child who had tod stra/bismus. We found the mother had very bad varicose veins and ,
UhTSSS ST;« S!^ "J? ""^ ears> *** of whom hid very large tonsils.
? 4™+ L^L^  ? wawera there. He had apparently joined a Blud Cross group and
has just been waiting for the slip before having these conditions attended to. The mother
however, was not planning to have anything done about her veins.
-,.. /^J11? Se!e visits "* delivered a couple of posters regarding an immunization clinic to be held in the Navy Hall at Lewisburg next week. We then went to see the
old Fort and called for a few moments at the museum. I was disappointed that I could
not see the surrounding country as it was foggy all the time we were there. The little
harbours and fishing hamlets looked very attractive.
In discussing with Miss MacDonald the  solution to some of our personnel prblems
she feels that the  taking on of the untrained public health nurse is the only solution*
Would like to take oh more of them with the understanding that they would take public
health at the end of a year at least. She did not seem to feel, at first, that a course
should be started at Dalhousie. She felt that when there are good course established
already that the nurses should go to one of the existing universities. I pointed out to
her however, that when the girl gets away from the Maritimes she is frequently offered a
job at a much better salary and does not return. Also that an attempt to increase the
number of ■ahamla students attending to fill the needs in other provinces that the
existing facilities would not be enough. I think she agreed that a course might be
started at Dalhousie even under existing conditions. That we cannot await until field
work is ideal. The great problem here is definitely shortage. They are all set to
expand and will do so as soon as they can get more personnel.
July 29. 1948. - Left Sydney about noon to call at the Gaelic Mod at St. Anne on the way
to Baedec. Dr. Baillie drove down with Dr. MacDonald just ahead of me. It was a very
beautiful drive down the lake. When we got to the Rock ferry theirs was the last ear to
go on and I had to wait for the next one. Froa the other side we drove up to St. Anne,
a short but attractive piece of country. The Gaelic Mod is just like one big picnic.
When we arrived some bagpipes were being played and there was a competition of singing,
Scots songs without any accompaniment. There followed some Highland dancing by groups of
girls. Lord and Lady MacDonald along with Premier Angus MacDonald and other notables were
on the platform. It was a burning hot day and everybody was feeling the heat somewhat.
The Mod was held at the Gaelic College and the bleachers were out on the open on a slope
of ground facing down to the lake with the hills on the other side. After about an hour
and a half there we drove on to Baedec. Dr. Baillie stayed at the Inverary, but as the
whole place was very crowded I could not get a room there and had arranged to stay with
Miss lytle in her apartment. We went fishing with Dr. and Mrs. MacMillan and Miss Lytle
in the evening and after that stopped off at the MacMillan*s. We did not leave there until,
after 2 a.m. It was a gay party. Mrs. MacMillan is rather deaf and to have visitors like
this was quite an event or so she said. She was most anxious to make a party of it.
Miss Lytle also had some other people in her apartment and she stayed at Mrs. MacMillan's.
The next day went with Miss lytle on a visit. It is a pleasure to find that she
is doing a great deal of child welfare and pre-natal work, after seeing most of the other
nurses in Nova Scotia concentrating on tuberculosis. Apparently her tuberculosis problem
is not so great. Hers is also a unique situation. Dr. MacMillan is the medical health
officer. He is a general practitioner and is somewhat of the old family type of doctor.   <
There is no hsopital in the area although before very long there will be a Red Cross
Outpost. Consequently there are many home confinements and Miss lytle assists with them
all. She is thus able to give some pre-natal home supervision and able to follow up the
supervision through her clinic and her home visits. She has some 85 schools, her territory
has been increased within the last year or so. Interestingly enough she is not doing as
much pre-natal work in her new area. This seems to have something to do with the doctor
and the particular situation which has grown up in and around Baedec. Miss Lytle has
k
 -5*»
a very nice office in one of the town buildings. The hallway of the building serves as
a waiting^room when she has a clinic every third Friday. She  is also in the office
every Friday afternoon and the mothers know this. On the Friday that I was there already
by three o«clock more than half a dozen mothers had arrived. She takes them into her
room individually and sits down on a comfortable couch and talks with the mother. If
S?7 a"\nuTsea could have a set-up like this, much greater respect would be paid to
the public health nurse and her work would be much more effective. Although I know that
this particular method of doing public health nursing may be very much open to criticism
in that the public health nurse is almost serving as an assistant to the doctor, never
the less, Miss Lytle has established a relationship with her patients which I had not
seen elsewhere. She apparently has developed this set-up very much on her own. She
did not have a telephone of her own so one day she went out and said to three girls who
were sitting on the bench - "How about putting on a dance to-morrow night and paying for
a telephone for my office". A dance was put on and the telephone was secured and the
monthly fee paid for several months until Council could take it over.
The first visit made with Miss Lytle was an infant welfare visit. It so
happened that the mother had come into town. Miss Lytle knew this before she left and
Dr. McMillan, knowing that she was going to be home asked her to remove some sutures in
a little girl's foot which he had put in previously. I questioned this and wondered if
the mother could not have taken the little girl to town. Miss Lytle said, Undoubtedly
she could but as she was coming along and Dr. MacMillan had asked her, she was willing
to do it. However, apparently Dr. MacMillan does not save himself and would be just as
likely to make a call as to ask the mother to bring the child to hospital. This was a
very poor dirty home. A six weeks old baby was in a basket in the kitchen, it had never
been put out in the sunshine*
The next home was to visit a six weeks old baby, the first of a young mother who was
doing very well and is most anxious to have the nurse come and assist her with the baby.
She had the baby outside in a crib covered with a screen.
We made a third visit where there were young twins. Both babies had sore buttocks and
Miss L£tle gave very good instruction to the mother. This mother also did not have the
babies outside. It seems she has twins only a few months old and another set of twins
only a year older in addition to a litte four year old girl and she has her hands full.
In the ten years that Miss lytle has been in this area there have been over
500 home confinements. When the Red Cross Outpost Hospital is established they expect
that most of the mothers will come into hospital and it is Miss Lytle's intention to
educate them to this. It will however, be rather difficult for Dr. MacMillan to use the
hospital. He has been so used to going on his own. We took Dr. and Mrs. MacMillan and
Miss Lytle to lunch at the Inverary. Later in the afternoon we drove to Noraafay where
we were to stay the night and then go on to Inverness on Saturday. Dr. Baillie's mother
and fattier were in the district and in the evening they went fishing. In the morning yvJI
at 5.30 we went fishing again. I got up and went a^ong with them and then drove on to
Marguerite Harbour. It was very beautiful in the sunrise. Took a long walk on the
bluffs and on one bluff came to an old oemetary where most of the departed McLean's of
the area lie buried. I returned back up the valley,taking some photographs on the way
and also had a walk up the hillside along an old logging road. After breakfast we set
out for Inverness where we were to see Miss McDougall the public health nurse. We found
her office in a building on the main street. First of all, I should say that we had
been warned that we would find Inverness a very dreary place and it was. It is a coal
mining town and apparently for some time the coal mines have not been operating and
are just getting back into production. It is dreary and unprogressive looking and a
most unstimulating place in which to live. To get into Miss MacDougall's office there
was a high step to get into a very small room. There is just no place for privacy and
it certainly would not be an inviting place for anyone to come to conference with the
nurse. There is not even a sign on the door.
Miss MacDougall's area covers most of Inverness county from fW**»V~ Bay
down to Judique. She does not have Port Hawkesbury. Population is some 18,000.
 -52-
<ftettican*(>and area alone have 7,000. This was most surprising as it does not look to
be such a large place. Inverness has a population of around 25,00*. The hospital
facilities areas follows - 2 hospitals in Inverness, each with about 25 to 30 beds.
1 in Chetticairtpand 1 in Port Hawkesbury. There are two doctors in Inverness, three in
Chetticantpand two in Port Hawkesbury.
Miss McDougall did not seem to be very familiar with the staffing and work in
the hospitals. I do not think she has much contact with them or has endeavored to
develop the public health nursing contacts. Most of the maternity cases come to hospital. She has had two confinements in the last four years. She admitted that there were
still some who were confined at home but apparently the nurse did not call. She stated
the doctors are not interested in pre-natal work. There is a check-off system here
also. I do not think that she has gone to very great trouble to have the doctors refer
the pre-natal cases to her. She has no clinics for babies and no time in which the
mothers can come to her office, and as I stated before, it is not a very inviting place
to come to. She does not get any lists from the hospitals or is not notified of births.
She says that very few mothers are breast feeding their babies. She tries to do all
the education she can in the home visit.
the fall.
There are two tuberculosis clinics held in this area, in the spring and in
Has only about ten cases waiting for hospital.
In relation to venereal disease she says there are plenty of cases which she
has not on her file.
There is no welfare representative in Inverness, The nearest is Sydney.
She has 77 schools and a population of around 3,000. French is the language used in
most of the schools around Chetticant. She said it would be a definite advantage if
she were bilingual. There are only three dentists in Inverness county, one in Inverness
one in Chetticant and one in Port Hawkedsbury. She has an immunization clinic once a
year in Inverness, about fifty attend. Miss MacDougall does the immunizing herself in
this situation. Permission has been given for her to do this. The M.O.H. for the
rural area of Inverness is a Dr. McNeill, stationed at Ma&m* He is over 80 and his
technique in Immunization is very poor. Miss MacDougall was going on her holidays
next day and after that expects to be transferred to Halifax County. She has been in
Inverness for four years and one would definitely feel that was long enough for any
nurse to be in that situation. Miss MacDonald was very concerned about Miss MacDougall«
She thought that either there was some physical condition or that there was something
bothering her in her home situation. I felt that she was rather slow in her responses
and did not have as good a knowledge of the area as she should have. Dr. Baillie,
however, did not agree, and thought it was very difficult for her to answer when two
strengers came in and started questioning. He felt that she did know the situation
and knew what should be done. In the face of the great distances and the large population and the many problems, it must be very frustrating for the nurse. There are so
many things to do and she can only skim the surface* Perhaps they need some guidance
in the manner in which most work can be done in the easiest way. For instance, I do
think that Miss Lytle »s system of being in the office and the mother coming in is very
good. For one thing, the people are coming to the nurse and not the nurse going p>
the people. In a town the size of Inverness there are bound to be people coming in
from the rural areas for their shopping, and many of them would come to the nurse if
she would only try to build up this service. The provincial department Should also   j*
take more responsibility in obtaining suitable quarters for her if she does not have
the initiative to go ahead and get them herself.
We left Cape Breton and drove on to Pictou on Saturday afternoon. We felt
last we had had a very interesting and a very profitable time in our three weeks of
survey work there. I learned a great deal about the problem. They are much greater
than I had realized and their shortage is more acute. The country is very lovely and
it should be a very nice place to work, if only there were more nurses and there was
 1
not the frustration of so much to do and so few hands to do it. There definitely needs
to be more guidance from the provincial department nursing office. If only there could
be someone appointed as an Educational Director, to help the nurses keep up with the
latest information in public health nursing and give to them some inspiration. One felt
that they were most happy to have someone from outside with whom they could talk over
their problems. As it is, more and more seems to be thrust on them without any preparation for it, as an example, the venereal disease. Now the mental hygiene is being
developed and they simply have not time to take on more and yet if they don't, other
workers will be put into the field*
We stayed in Pictou at the Braeside Inn on Saturday night and on Sunday drove
on over the Sunrise Trail through Pugwa^sSand Mockton to Fredericton, where we stayed
at the Lord Beaverbbook Hotel. A new one of the Lord Elgin series. It was very hastily -i
constructed and was made ready for the Centennial which was held last week in Frederictoi
It has a very beautiful location, right on the river and a promenade at the back goes
right along the river bank.
 -54-
NEW BRUNSWICK
August 2, 1948 - Meeting in Dr. Melanson's office at 10 a.m. with Dr. Melanson, Miss
Hunter, Dr. Trask of Saint John and Miss Siemens of St. John, V.O.N. This comprises
the provincial consultant committee,
u u a ^^^J^' Vel&iaaon had been sent the list of questions which we had drawn
up he had not distributed them to anyone. Miss Hunter had been given a copy at Sackville, but Miss Siemens or Dr. Trask did not know what the meeting was about.
Dr. Baillie started off in the usual manner by telling them about the Survey.
We then asked for their major public health problems. Without any hesitation they all
said - lack of trained personnel. This is really very acute in New Brunswick. We asked.,
why there was such a lack of public health nurses. The main thing seems to be that the
nurses are not provided with cars and they must have one. At the present time they
receive In mileage, 100 for the first 8,000 miles; 9* for the next 4,000 and 8* for
anything over that. The Government will buy a car for the nurse and she has three years
to pay for it at a very low rate of interest. Even this, however, is too much for the
nurse to undertake when She is probably just finished her University course and is in
debt for it. They could take on graduate nurses without their public health training
but here the problem of getting a car is even greater. A second reason is that it is a
rural set-up and they have to take a lot of responsibility with a minimum of supervision
and direction. The young nurse feels this very much is almost afraid to set out on
her own. They offered scholarships for training, the scholarship amounts to #500.00
and they must agree to stay for two years. This is only a verbal agreement. There has
never been any limit to the number to be given because they have never had too many
apply. Actually, since 1943, they have only had 5 or 6. Last year there was only 1,
and the year before that, none. The salary is very little, if any more, than the
nurses are getting in hospital and is not as much as the D.V.A. can give. Apparently
there has been a great loss of nurses to the D.V.A., who can offer so much higher
salaries. There are only about ten nurses on the Health Dept. staff. They lost four
last year and are losing three now and they are having three more to replace them. I
think they will all, or practically all, be public health trained. In addition to the
Jfept of Health staff, there are 8 centres where there is a V.O.N, nurse, about 20 V.O.N,
nurses in all. Saint John city has five nurses, T.B. Association, Saint John, has two,
V.D. Clinic, Saint John - one. In Moncton their is a school nurse and also a T.B.
nurse, supported by the Gyro T.B. Association. In one or two other centres there are
also specialized services.
The population of New Brunswick is some 480,000. If there were to be one
nurse for 5,000 people, which is needed, about 90 nurses could be employed. They
outlined the counties, the number of nurses, and the medical officers in each. Miss
Hunter will send me a list. Each county has its own Board of Health. Five counties
have to have bi-lingual nurses, This is another difficulty. We then discussed the
shortage of doctors and why. It boils down to the fact that doctors will not come
because of the salary. Dr. Trask said those he has are only there because they have
some other income. He did not feel that they could* live on their salary. They stated
that the public are ready for the service but they just cannot supply it. They get
one program built up and the nurse goes and perhaps the area is without a nurse for    j
some time. They did not seem to feel that any one particular service was a gaxj greater,
problem than another. The nurses concentrated on the greatest need. In some places
it is one service, in another another service. For example, in Westmoreland, they are .
concentrating on the school and child welfare service. They are trying this out as an
experiment. Miss Hunter is building up child welfare conferences. She has some 45 and
these are held in very small centres. Sometimes not even in a village. It id amazing
to them how the rural people will come. At first they seem to be just immunization
clinics and the nurses did not like this. But once the immunization is over they are
continuing to come and some mothers are bringing babies much too young for immunization
yJdi
 -109-
^?HS^b!lM^+B^h°Puapparently has secured it fro. them. If they have very poor
teeth or eyesight they have two dentists and an optometrist to whom they may refer
cases, that is patients who do not have their own or who find difficulty in paying.
The Patients will pay a third and the company pays two-thirds. This amount being
deducted from the pay-roll at the rate of one dollar per week. They try to folaow up
and do a routine physical examination every one and a half to two years. They have
insurance benefits at the end of three months employement when the employee is automatically insured. However, this behefit covers the worker only and does not cover the
family.
The second phase of the program is the first aid. This is made an opportunity
for health teaching. During the time that I was in the office only about a dozen
employees came in for consultation and treatment. Some of these were for straight
health consultation. Miss Bishop said that more come in for this than for first aid.
There is a very friendly feeling in the plant. All those on the office staff and the
executive group call each other by their first names and one has a feeling that the
nurse is frequently consulted. I notieced that she was wearing a pin "Safety Committee"
The first phase of the program is educational, as mentioned previously, they are doing
quite a bit of work in relation to nutrition. They feel very definitely that the worker
. must be happy in his job and they try to solve any of the little mental hggiene problems!
which might arise. This year they have obtained the service of the Toronto? night class-'
es and have referred several to them. Miss Bishop seems to make very good use of the
community resources. She knows them and expressed a desire to become better acquainted
with the individual worker. One has the feeling that she uses every jbossible opportun- '
ity to refer the employees to the proper agencies when it is necessary. If there is a
pre-natal case, employed by the company or if it happens to be the wife of one of the
employees, she refers them to the pre-natal classes conducted by the various agencies
in Toronto. Because staphylococcus infection is one of the hazards of this industry
or rather one of the dangers to the public buying the product of this industry, there
is an inspection of the hands and skin of the workers every morning. If there is any
evidence of infection they are moved off the job if they happen to be handling or are
in direct contact with the ingredients of the food produced. Dr. Harrison said it was ,,
the only baking industry in Canada which carries out this inspection and he seemed
quite proud of it.
One had a feeling with Miss Bishop that very definitely she was putting her
public health nursing preparation and experience to very good use, even though there
are only about four hundred employees, she seemed to be quite busy. She feels that
every industrial nurse should have a generalized course. That the hazards of the
particular industry have to be learned on the job and that more about industrial nursing,
can be learned through refresher courses, institutes, etc. She felt very definitely
that one needed to have had some community experience.
Later on in the afternoon, Dr. Henderson took me to the Dupont plant where  ;|
they make bread and cakes. This has considerably more employees. Miss Guy is also
a public health nurse and carries on much the same type of program as Miss Bishop.
They seem to be using quite a few biologicals, giving vitamin BI, Beminol, StafKyloco-
ccus toxoid, etc• J■
2. Colgate, Palmolive, Peet. This was the second industry visited. It is on Natalie a
Street. The nurse is Miss Grogan. She has not had public health. Her background was I
private duty and for the last ten years she has been in this industry. They have about
six hundred employees, nearly fourhundred of whom are men. In addition there are two
hundred and twenty-four office employees. I was not conducted around this plant so I
do not know very much about the set-up. The chief hazard seems to be burns. The
medical room is on the first floor and is referred to and named - the First Aid. It
consists of an outer office in which the nurse has her desk. A middle room, quite a
large size which is the dispensary and two small rooms off of that in each of which
there is a bed for patients to rest. Miss Grogan is full time. There is a doctor on
 -55-
This has been very gratifying to the nursing service as they really want to do a
piece of educational work in child health through these conferences. I think thia
disproves the theory that you cannot have child health conferences in rural areas.
Miss Hunter is very insistent on using the word "Conference" instead of "clinic". The
need for personnel is so great that they do not know where to start. For example
Gloucester County has a population of 52,000 and there is one nurse and she is overwhelmed with all the problems. They are skimming the surface everywhere on everything.
For three to four months ln the winter the roads in the country are impassable. A
doctor stated that one of the most discouraging things about public health is that you
get your teeth into a problem and before you finish it you have to start In on another,
there are just so many problems. Saint John has the second highest infant nortality
rate in Canada, Dr. Trask attributes this mostly to poor housing. Of 1,300 houses
which were ordered demolished in 1932, 1,120 are still standing. New Brunswick as a win
whole has the highest infant nortality rate in Canada.
In trying to find out what they consider their biggest service problem they
finally said that probably it was tuberculosis. In New Brunswick the nurses do the
immunization and vaccination everywhere except in St. Stephen. There the doctors
object to the nurse doing anything for the school children. She does the immunization
however, for infants. No one knew why the doctors made this distinction. Dr. Trask
has never approached them on the subject.
In relation to mental hygiene, there are no facilities. The nurses are doing
a great deal in the homes in the way of preventive mental health through their conferencing with mothers. It was agreed that they are not getting enough training, either
nurses or the doctors, in mental hygiene. Dr. Trask says he did'nt know anything about
it and did'nt want to know. The nurses felt that the doctors should have more mental
hygiene and that they should act as consultants to the nurses in this effect.
Welfare for the province of New Brunswick is under the Minister of Health.
There is a Director of Old Age Pensions and Blind. There is a provincial Child Welfare
Officer, who is responsible to the M.O.H. This is an untrained person. There is a
C.A.S. representative in each county. Only a few of these are qualified workers.
Miss Hunter stated that one-half to three-quarters of the T.B. problem is not nursing
but welfare. She feels that the nurse should not have to do this. It is just another
thing added and they get more bogged down than ever.
After lunch Miss Hunter, Miss Siaman and I met together. We discussed the
preparation of the nurse. They both stated that nurses are dissatisfied with their
courses. Miss Hunter said - dissatisfaction is so general that there must be something
wrong. They felt that there is not enough given on mental hygiene. Sometimes it
varies with the year the course is taken. For example, at McGill, one year when Dr.
Silverman gave the course, it was excellent. This last year he only took two or three
lectures and then was followed by another doctor whose lectures were largely psychiatry I
Also, the social ease work which was given at McGill was very poor and the field work
opportunities are not good enough. They do not have enough help in working out the
real problems, or at least, in working the problems through to a solution. They feel ''
that more is needed on public speaking. They get a lot of things they already know,
but they want to know how to apply this information. What Miss Sieman and Miss Hunter
felt is that perhaps they are looking for too much in the course and that after a year
or two back in the area they realize what value they did get from it. They go to the j
course with the idea that they are going to get everything and all their problems will
be solved. It would be an idea to see what could be done through Miss Deanings's
merit system test in sorae university, to build on the knowledge the student already
has. Let them know the facts they should know but do not know that they will have to
obtain these themselves, and then concentrate during the university course on teaching
then how to teach public health. Both Miss Hunter and Miss Sieman felt that there was
not enough on the basix principles of recording. They said it is a rare nurse who can
do a good job on records. For one thing they are done at the tail-end of the day  j,
Jm\
 -56-
when the nurse is tired. This is perhaps, bad. They need more on V.D. More and
more venereal disease should be included in the generalized program and in so many
places she is not being given instruction on this. All nurses should be taught to
drive a car. She said that when a nurse has to learn to run a car and has to undertake a rural district both in her first year, it is almost too much for her. Several
of her nurses have remarked on this. They felt that the hospital supervisors and
instructors do not have any idea of what we mean by incidental teaching. The nurses
are not given this idea in the hospital and it is very difficult to pick it up in
public health. There is a great need for more teaching in the sanatoria so that the
patients will be better educated when they come back to the. district. Miss Hunter
stated very emphatically that the doctors need to be taught how to work with nurses.
By the she meant that so many of the doctors do not seem to know how to plan a
program and that they do not realize that they must plan it along with the nurse. In
some of the areas the nurses have clerical assistance. The clerk is paid on an hourly i
basis. The nurses are free to obtain this assitance wherever and whenever they can.
Conpleted key form with Miss Hunter. Felt that this should be done for the zpcmkx
provincial department since the service in Saint John is somewhat different and also >
the one in Moncton would only be one of the rural areas. This should probably be
done for each province. There is also need to allow more time in our visits to spend
with the provincial workers. They are, after all, the ones who direct the policy.
Miss Hunter is to send me her own job analysis, the statistical information, a list
of the counties with population, nurses, etc., a copy of the agenda for the staff
education program, and a copy of the lectures given to the Normal School students.
After dinner we drove to Saint John, Dr. Baillie going with Dr. Trask and
Miss Sieman coming with me. We arrived at the Admiral Beattie to find that our
reservations had been cancelled. We obtained rooms in a very nice old house at 30
Queen Street. This is a place which the hotel sometimes use when they have no place
for guests. It was a very lovely home, beautifully furnished. Saint John homes
seem to be something like the homes in Boston. They are built right out on the streel
without any lawn, and look like terrible places, but when you get inside, they are
beautifully furnished and very lovely.
August 3. 1948 - At 8.30 in the morning met with the V.O.N, nurses and afterwards
talked with Miss Steman and completed key form. Miss SSfcman has built up a very
good industrial nursing service. It started at Eastern Textiles with the service
being a purely health education one. Miss Sieman herself started this. (See form
on industrial service for further information). Miss Sieman gave me a list of the
other areas where there are V.O.N, in New Brunswick. Moncton - 4; Sackville - 2;
also where they do school service and well-baby conferences; Newcastle - 1 where thej
do schools, tuberculosis and well-baby conference) Chatham - 1, schools, T.B., and.
well-baby conference; Campbellville - 1 where they do schools and well-baby conferences; . Woodstock - 1, and there they also assist the Dept. of Health with T.B. and
well-baby conferences; Fredericton - 2, do the school work and well-baby conference;
Saint John - 7 and supervisors.
Miss Sieman has developed a very happy staff of nurses. She has done
everything to make their work more pleasant and more interesting. When she first
came they were doing, very largely, a bed-side service. She has added pre-natal
service and the industry and the nurses like it very much better. There is no over- L
lapping of the service with the Health Department as described in ttje key form a list'
containing information to admissions and discharges is sent to the ealth Dept. egery
Saturday. They also obtain referrals from the hospital. There are three hospitals
of which the largest is the General. There is a Catholic hospital and a Salvation
Army hospital. There is not so much co-operation with the latter two. Miss Sieman
would like to have more nurses and do a larger industrial program and start pre-natal
classes. They have recently added some of the outside areas of Saint John.
In the building which houses the V.O.N, there is also the Children's Afcjj
 -57-
Aid Society, Family Welfare and the Tuberculosis Association. Following my talk with
Miss Sieman I went upstairs to see Miss Clark who is a tuberculosis nurse. In Saint
John the T.B. work is done by this private organization, which is financed by the seal
•^^'u ^! s*af£ucon8ists of Miss M.L. Clark, who took her public health in Toronto
and Miss MacDonald who has not had public health but has had some post-graduate work
in tuberculosis. Did not meet Miss MacDonald as she was away on her holidays. There
is one clerk. Miss Clark says they could use another nurse but she wants to have a
qualified one, that is, one with public health. But because of the low salaries she
finds it very difficult to obtain anyone. They can only offer $1,600. Miss Clark
herself is getting less than $1,800. They have a clinic twice a week in the afternoon
from 2 to 4 p.m. except during the month of July and August. The medical staff of
the Tuberculosis hospital give their services free. They are able to fluoroscope only,
the x-raying is done at the hospital. There average attendance is around thirty. The
nurses do the home supervision of Saint John city and county. They teach the case and ,
the family the care necessary to prevent the spread of the disease. They are all
taught to wash and soak the linen in lysol before washing. The patient should have
separate towels and that the dishes should be kept separate with a separate tray and
pan for sterilizing. This is taught for all cases at home, including post-sanatorium
cases. The frequency of visits depends on the time and the case. Their case load is
as follows -
Families - 642
Cases - 363
Contacts - 704
In Saint John the living conditions are very poor. Miss Clark says there is some overlapping with the Health Dept. but they try to avoid this by having the Health Dept.
nurses, also the V.O.N., patch test any contacts in the homes that they are visiting.
Sample of the records was obtained. They use a family folder and a clinic slip. They
have a list for home visits which are kept in a black book carried by the nurses. This
slip is attached to the record for the doctor's information when a clinic is held.
There are a great many social problems, these are referred to the Family Welfare. As
the office of Famil Welfare is just across the hall there is a much better chance of a
good working relationship. The head of the Family Welfare is a trained social worker.
Miss Clark says they report their eases where there are social problems, these are not
only where material relief is necessary. I felt that Miss Clark had rather a good
understanding of the social aspects. She feels very definitely the need for a medical \
social worker in the sanatorium. She feels also that the nurses are not getting enough
on teaching in their undergraduate course. As it is not necessary to have affiliation
in New Brunswick, many of them are afraid of tuberculosis. The teaching done in the
sanatorium where they are at present desperately short of nurses is very poor.
Consequently when the patient comes from hospital he has not been educated as he should
and needs closer sxq>ervision at home. Miss Clark is not able to call regularly at the
sanatorium. The nurses are asked regarding home conditions for the case is ready for
discharge from the local Sanatorium. However, many of their cases are in sanatorium!
away from this area and quite frequently the case ariives home before they know anything about it. Arranged to make some visits with Miss Clark. Asked her to complete
a job analysis form and send it to me later. She will fill it in with the idea in
mind of analysing the work done in a specialized T.B. service with respect to the amoun
which is nursing and the amount which is welfare,
A couple of days later I saw Mrs, Warnford who is head of the Family Welfare ;
Bureau along with Miss Clarke. Mrs. Warnford is a trained social worker. She  intended
leaving her work shortly after the war but at that time became very interested in the I
housing and she apparently is the one who is working closely with other officials and u
pushing the City Council and stimulating their Interest. Mrs. Warnford spoke of the
close working relationship with Miss Clark and the T.B. problems. She suggested some
places to which Miss Clark might take me to show me the housing in the city.
Our first visit was to the emergency housing shelter where we saw a husband
who was very nice indeed. This was wd^obdc one of their better tenants. We then .
 -58-
drove around to Bookmood Court Apartments which are being built. They are going to rent
for something like $80.00 a month. Mrs. Warnford feels that by paying $15 to$lS dollars
a month and bating your own place you are paying more than straight $60 a month rent.
Not all agree with this. We then saw some of the other housing developements such as
Fundy Heights which were started by the Insurance company and taken over by the Canada
Mortgage. Dr. Trask happens to have one of these houses.
We made a visit to a family on the top story of a very rickety old house. They
were three flights up. We went in the front entrance. The first flight was dimly lighted. The last two were dark as pitch and I had to feel my way. Only a little over a
year ago a rear exit was made for this family. This was somewhat lighter. There were
fourteen children in the family. The father is an old thoro$kasty, now working on a
boat. The mother is of somewhat dull mentality. The two girls who were at home had
taken hold and really tidied the place up. The older of the two girls, 13 years, was a  ,
very attractive youngster and very nicely spoken. What an environment for her to be in.
Miss Clark is a very nervous individual and it would not be possible to visit with her in
relation to teaching which she does in the homes.
It is too bad that in Saint John this program is a specialized one. It is being
done, I am sure, quite efficiently by Miss Clark^, but would be so much better and so
much more interesting to the nurses of the city department if it could be included in
their program.
The same is true of the V.D, work. Visited the clinic on August 5th. Mrs.
McLaren is the nurse in charge who gives the treatment to the women. Women's clinics
are held every day except Sunday from 9 to 12.30 a.m., and from 2 to 5 for five days a
week. The mens clinics are held every evening from 6 to 7. Internes from the hospital
give the treatment at the men's clinic. Routine treatment is given. If a case comes in
which has not been diagnosed they are referred to Dr. Emmett. If they are suspects the
nurse takes blood and smears, and if diagnosed positive, treatment is set up. This may
be done without the doctor having seen the patient. The penicillin treatment has greatly
decreased the work of the clinic. The average per day is about 20, includes both treatments, Mrs. Dunlop is the social worker. She is a trained worker and has had some
field work with the V.D. division in Vancouver. She follows up all cases. Every new
patient is referred to her. She is supposed to trace the contacts. This may be done by
sending out a note or first, making a visit. Both Mrs. McLaren and Mrs. Dunlop state
that there is very little delinquency.
August 5. 1948 - Saw Miss Lamb at the V.O.N. Miss Lamb is a student from McGill. She
is taking the degree course and I was anxious to find out about it. She has completed
her first year. There are about ten in her class. They are asked to get field work
before entering the course if at all possible. It was not possible for her to do so.
In her first year she took public health nursing; teaching; trends in nursing; psychology j
nutrition, phsyiology, this includes a three hour lab. and is taken with the pre-meds;
organic chemistry which also Includes a three hour lab; and social medicine. She then
has to have two months field work. She is having her field work with the V.O.N, They
all have to do this. She is taking three months. The first month without salary, the
last two months they get a certain amount.
In her second year she will soci/ology; education; mental adjustment; social medicine;
public health nursing and the field work will be in the various agencies around Montreal.
Asked Miss Lamb in relation to her physiology if she did not feel that she had had enough r
in her preliminary nursing course for public health. She thought that physiology gave
her a much better understanding than she had had previously. Organic chemistry, possibly
there is not much in this which is going to assist her in public health nursing.
Following my interview with Miss Lamb, went with Miss Mclntyre to the
industries which she goes to from 9 to 10 every morning. This is a large departmen
 5S
-59-
t^T* i£^+J£! *  second industrial nursing service started by the V.O.N, in Saint J
John. Tha store has about 250 employees. Unfortunately, the personnel manager with,
whom the nurse works is not very cooperative. The room ised by the nurse is a sfifiinS
room, it has a bed, a wheel chair, a small table and first aid cabinet. There is no
running water. The nurse has tried to get a card for all new employees. It is
supposed to be routine that new employees are sent to the nurse. There is no routine
physical examination. As Miss Mclntyre is there for only one hour each day, it is
almost impossible to do anything more than a first aid service. The average daily
attendance is July was 4.19. While I was there two women came in to have bandages
replaced on their ankles. Bothmx of these seemed to be chronic. Miss Mclntyre has just
taken over the service and is planning to develop it as far as possible. She has been
trying to get the records in order and is going to try to arrange to see three or four
new employees each day. However, the difficulty seems to be lack of cooperation with
the personnel manager. One wonders how far we are justified in using public health
nursing personnel to develop industrial nursing services such as this.
Interviewed Miss Law, Registrar of the New Brunswick Registered Nurses
Association, she is very concerned about the nursing shortage and especially the shortage of supervisors and instructors. New Brunswick has 14 schools of nursing, graduating from 185 to 200 nurses each year. The schools seem to be getting their supply of
applicants, but the smaller ones are sometimes finding it rather difficult. The three
small hospitals which have schools are - Campbellton with 70 beds; Merimache with 65
beds and Woodstock with 65 beds.
Student nurses in New Brunswick have psychiatric affiliation but do not have
any T.B. affiliation. There is no public health nurse on any hospital staff. Nursing
assistants are used in hospitals. The C.W.T. training program is still going on and
these girls are quickly absorbed. Some hospitals are taking in their own and giving
their training. Miss Law feels very definitely that the difficulty°Che provincial
department of obtaining public health nurses is because of having to supply a car.
Asked regarding salaries in hospitals - the Saint John general is the best pay. Chief
instructor, nurses - $145 a month plus maintenance. Her two assistants - $110 and $100
per month, plus maintenance, respectively. The obstetric supervisor who has had a post
graduate course ln obstetrics and has had three years experience, receives $145 plus
maintenance. Floor supervisors with two years experience, but no post graduate course,
receive $110 and maintenance. General duty nurses with two years experience and over
receive $115 with meals and laundry only. In the smaller hospitals the general duty
nurses receive $1260 to $1380 a year with full maintenance. Comparing with the public
health nurse who finds it difficult to get board at $35 or $40 a month, the public
health nurse is not much further ahead, if any.
August 6. 1948 - Had lunch and interview with Miss Ramsay who was the social service
worker at the Saint John General Hospital. This hospital had a social service dept.
about twenty years ago but were not satisfied. It has started up again this last year
when Miss Ramsay'took it on. Miss Ramsay has had several years teaching experience
and has recently taken her social work at Dalhousie. The understanding when she went
to the department was that 75% of her time would be spent investigating the financial
details of admission of patients and 25# in case work. I think that she has readjusted
this now. We discussed social work in general and medical social work. I went over my
notes of the Hamilton Institute and gave her an extra copy. She seems very interested
in her work but she has a hard row to hoe. She spoke very highly of the cooperation
of the nurses.
August 4. 1948 - Spent the day with the Saint John Board of Health nurses. Interviewed
the two nursew who were on duty, Miss Donovan and Miss MacDonald in the morning, and
visited the clinic in the afternoon. The staff of nurses consists of, Miss Jenning
who was on holidays and who acts as a senior nurse. Miss MacDoaald who is leaving at I
M
 -60-
the end of the week is the only one with public health qualifications. Miss Wilcox
who was on holidays. Miss Thompson who is leaving to take the course in Toronto this
winter and Miss Donovan. Miss Donovan is the one who has acted as senior in Miss
Jennings absence.
The area includes the city of Saint John and suburbs and the county of Saint
John. Previous to January of this year, three of the nurses did the school nursing p
program and three did the infant welfare, including both infant and pre-school. This
consisted mostly of clinic work. At the present time Saint John city and suburbs are
divided among the six nurses. There are twenty-six schools in this area. These
nurses also carry the pre-school. There are five clinics, one held each afternoon.
There are 29 schools in the rural areas. These are not definitely assigned to nurses,
whoever is available, goes. The work in these schools is done in the spring and fall
due to travel conditions. There is no infant welfare program in the county. Each
nurse is provided with a street car pass. County work is done with the use of the
Board of Health car. A sanitary inspector drives this car and when the nurses want to
go to the schools the sanitary inspector drives them. He does his work as a sanitary
inspector, which probably takes a very short time and then waits for the nurse. Sometimes the doctor may take the nurse, as has happened this past winter when Dr. Trask
has been doing some experimental examinations in the schools. No high school work is
done, there has been no patch testing. Pre/-school immunizations are done in the rural!
area in the schools at the same time as the school children. When they prepare for an
immunization clinic they let the teacher know when they are coming and send her consent
slips. She sends them home and makes out a list of the children in the school.
According to Miss MacDonald a great deal of the time is taken up with
pediculosis. There is no regular program of visiting the city schools. Children with
pediculosis are excluded and must report to the Health Office for re-admission. If a
child has had pediculi and they have been cleared up, he reports at the office. If j&sa
there are still nits he may be told to come back for re-inspection. This may happen
over and over again until the families get into the habit of coming to the office.
There is one nurse in the office every aftecnoon for this purpose. There are sometimes
las'many as 100 children reporting. She feels that there is far too much time wasted on
this and that the teachers could take some responsibility.
The school program' consists of -
(a) a general survey of the classes three times a year after holidays,
done in each class and there is a routine class inspection.
This is usually
(b) Examination of grades 2, 3 and 5. Teeth, throat, hearing and vision. They do not
weigh the children. Sometimes, if there are scales at the school, the teacher wiH
weigh the children but the nurse has no record of the weight. Usually this examination
is done by taking the children to some vacant room. There are no health service rooms
in the schools.
(c) Grades 1, 4, 6, 7 and 8 are given a less thorough examination. Sometimes this is
done outside the class and sometimes in.
The parents do not come to the school. Nurses send home notices of defects
and try to do as much follow-up work as possible. However, since the nurses are in the^
school every morning, and each nurse attends two to three clinics in the afternoon,
and it is necessary to be oh duty at the office one afternoon, this only leaves one or
two afternoons a week for home visiting, and this must be divided among school and
infant welfare cases.
In relation to communicable diseases, the nurses do not report. For example,
if they are told by a teacher that a certain child has chickenpox and that has not been
reported to the family doctor, they wial not bother reporting it, at least they
 -61-
have not been requested to report it. The nurse does not make exclusions bf contacts*
This is done by the teacher. (See Communicable Diseases Regulations on card which is
supplied to all teachers.) The case must come to the Health Officer or the private
doctor for a certificate for re-entry.
There are no mental hygiene facilities. There is an eye clinic which is
attended by one of the nurses every Saturday morning during the winter months. Cases
are referred from the school. There is a dental clinic which is held every morning
from 9-12.
The infant and pre-school programme is chiefly done through the Well-baby
clinics, which are held every afternoon except Saturday, The babies are weighed and
the mothers are interviewed. In my observations, it seemed as though this interview
was very sketchy. The nurse sits down by the mother, while the mother is dressing or ,
undressing the baby and the» may be other mothers right nearby. Babies are immunized
and vaccinated at the clinic by the nurses. They usually have a volunteer who draws
the records and sometimes weighs the baby. She writes the date on the baby's weight
card and on the clinic card. The average attendance at the clinic is 45 to 47. The
two clinics which I attended, one at St. David's United Church and one at Portland St.
United Church. At the first clinic there were 70, 35 were there for immunization,
about 10 were new babies. At the second clinic there were 47, and 28 were there fir
immunization* There were 2 new babies. A list is made by the volunteer of all infante
and pre-schools who attend the clinic. These are checked by the nurse with the cards
and serves as a count. This seems quite unnecessary. One of the nurses looks after
the immunization clinic, she makes out the cards. The baby's clinic records is taken
to the office and the information entered at the clinic is transferred to a duplicate
card which is kept in the office. This is done so that when the nurses make home
visits they can refer and know what was told to the mother at the clinic. However,
the record of the home visit is not entered on the clinic card but only on the office
copy. Not very many of the clinic cases are followed into the home.
In one of the clinics I attended there was a volunteer* She, however, did
not do any weighing* In the second clinic there was no volunteer. There were three
nurses. Two working on the Immunization and one interviewing mothers*
There is a very great need for nursing supervision and direction. Had a lon| ii,
talk with Miss MacDonald when I took her out on a home visit. She is the third nurse
with public health training to leave. The chief reason seems to be Mr. Mclntyre, who
is the secretary of the Board. He seems to control the nursing situation. Miss
MacDonald has frequently made some suggestions and I think she has probably done it in
the very best of faith. However, when those to tkw whom the suggestions are made
have left training and the one making the suggestions, they immediately rise up in
defence* This apparently has been the situation in regard to Miss MacDonald. She
has been said to lack tact. She has a very nice approach to the people when I saw
her working in the clinics and also during the home visits. She apparently finished
her course in Tbronto two yeais ago and is enthusiastic about public health* She did
not realize the kind of situation she had gotten herself into, and at the end of two
weeks here when she discovered that there really was not medical officer of health,
and when she found that the nurse in charge did not have public health training, she
went to Mr, Mclntyre and said she felt she had better resign. She was however,
persuaded to stay on. Several little things arose following suggestions made by her
which made her feel that she was getting in deeper and deeper but she resolved to
continue since she did not want to leave with bad friends. This has worried her very |
much and she has lost a lot of sleep over it. She really feels very upset about the r
whole thing and may be lost to public health. She told me at the end of ray interview
that Dr. Trask had asked her to resign. This is really a very bad situation. The
girl is leaving" feeling very frustrated. However, Dr. Trask cannot do very much about j
it I suppose. He also is in a very difficult spot, having to sit in the office with
Mr. Mclntyre. The only kind of person who can be put in this situation is a fully  fl
 -62-
qualified public health nurse who has had some years of experience and she must be
put in charge. As Miss MacDonald says, it is absolutely an impossible situation,
when a worker is trained to be put under a worker who has not had training. If
more supervisors were qualified and were good administrators were available and were
employed it would be much better use made of the existing public health nursing
staff. This is true in Saint John and in many other places.
Dr. Trask also has Charlotte county. There are two nurses there. One
provincial who has a rural area and the Island and one who is a Red Cross nurse
subsidized by the government. She does the work in Saint Stephen and Milltown.
area was not visited.
This
 -6>
PUBLIC HEALTH NURSING SERVTOE OF WESTMORLAND. KENT. AMD ALBERT COUNTY. N.B.
qt u^tlr,^™^ John, Sunday, Aug. ^th and after a very pleasant drive via
$r<T   ^r If  *? M!?Ct°n about 7 *•■• °* *»*»* mo™ing reported to Dr. Landry's
office. Dr. Landry is the District Medical Health Officer and his office is in the
Masonic Hall. Unfortunately it is not in the same building as the public health
nursing service. The  latter being housed in the Kinsman Health Clinic which is about
six or eight blocks away. In this building theieis also the V.O.N., the Welfare
Bureau, St. John Ambulance, Cancer Society of New Brunswick. This building is to be
enlarged and there is a possibility that Dr. Landry's office maybe included in it,
although he does not seem to be altogether sold on that idea.
Dr. Iandry's area includes the counties of Westmoreland, Kent and Albert.
There is supposed to be one nurse for each of the three counties. This last year
there has been Miss McLagMKwho was originally appointed for Westmoreland County and
two untrained nurses, the *two Miss Roys, As there was only one car, Miss McLagan's,
the work had to be arranged so that transportation could be together. Consequently,
Miss McLagan has had Westmoreland and Albert Counties and unofficially, has had Kent
county. The two Miss Roys finished while we were in Moncton. They are going to take
a public health nursing course at McGill and on the 28th of August, Miss McLagan «s
resignation becomes effective. She is going to take the Administration and Supervision course at McGill. Hiss Robadot has just returned from her public health
nursing course at McGill University. She was with the agency previous to her training
and is now going to be the one remaining nurse for this whole area of three counties,
unless it is possible to obtain some assistant.
In Westmoreland CountyT Miss McLagan started in 1946 with an experiment in
the school nursing service. She said she started it because she could not bring
herself to doing the routine inspection which nurses do in schools. She does not
agree that these are effective and her theory is that the teachers can screen the
children and find the defects just as well as the nurses.
In this comity there is a very fine and very alert superintendent of
schools, I believe he is called District Superintendent, his name is Mr, Chapman and
he has worked very closely with Miss McLagan in this project. In fact,she states
that many of the ideas are his, although I would imagine she contributed a great
many herself.
In June, 1946, she sent out a form asking the teachers to report the defects |
that they observed. She got a fairly good response from this. In September of 1946
she sent out a manual which she had prepared (see copy) and also asked the teachers
to send in a list of the defects which had been corrected. There was also a good
response from this. Which proved to her that teachers would report and they would
cooperate. There are 171 schools in Westmoreland county (this does not include the
separate shcools, of which there are a number). Mr. Chapman's plan for staff education in this area is to divide all these schools into 13 districts. Each of these
districts is what is called an "Association" and holds a monthly meeting. On the
afternoon of that meeting all the schools are closed. The nurse is present at this
monthly meeting or at as many of them as possible, and she has a real plan for health
education of the teachers. At the first meeting she discusses the manual and gives it
out, although that at the Teacher's Conference, which is a conference of the whole
district, and is held for one week in Moncton frust before school starts, is the time
when she gives out the manual. At these Association meetings she may give deraonstra- |
tion lessons, show films, she tells the teachers what to look <ffor in the children,
gives them home reminders for skin diseases, this is one of the most popular of the
classes and does everything possible to interpret the work of the nurse and to
interpret what real practical health education is,to the teacher. At the conference
which is held at the end of August there are general sessions at which the nurse
speaks and tells about the general policy of the health department and the relatio: |
 -64^
ship to the school, and then the groups are broken down into classes and the nurse has
a class for everyone with demonstration lessons, etc., may be given. Miss McLagan takes
an active part in the planning of these conferences. Miss McLagan was a school teacher
prior to taking nursing and one feels thafefiaais that this background has given her an
entre'and an understanding of the problems such as few public health nurses have. As
Miss Mclagan knew this year she was goipg to be leaving she did not follow up the program too intensely because she felt that ft would not be fair to another nurse unless that
other nurse was convinced that this was the way to handle the problem. As it is, with
the shortage of personnel, it is going to be very difficult to follow it up. However,
from the first year she had a very good response in the reporting of defects by the f.
teachers and in the completion of the forms for the survey as contained in the manual,
(see copy on file). In the back of the manual it will be noted on the original referral
form that the teachers would enter the result of the eye test. When Miss McLagan started out she planned to supply a Snellen Eye chart to each teacher. She, however, met   i
with a snag. The Regional Superintendent refused to supply the eye charts and has done
so on repeated occasions. His contention is that the teachers cannot screen children
for visual defects. He says the teachers will hang the charts up and the children will j
memorize the lines, etc. So, Miss McLagan had to make a new form as attached, and
leave out the results of the eye test. However, she maintains that the teachers can
tell whether or not there are gross defects of vision and that they do this. It is
Miss McLagan's contention that it is only gross defects which the teachers refer but
that they are as capable of finding these defects as are the nurses. Unfortunately,
she has not had the time to concentrate on this project and she did not at the same
time as the teachers ax referred in cases do a complete inspection of the class herself
to see how the teachers screening and the nurses inspection correlated. If this had
been done there would have been some very interesting figures from this study and she
has gone to a lot of work to make out cards for the individual cases referred and file
them. She also has all the information for each school in a separate folder. Miss
McLagan feels that this proves to her that first, teachers can report,; secondly, that
they can screen the children for gross defects; and thirdly, that if there is an adequate public health nursing service a much better follow-up service can be done and the
health education is greatly improved. By dealing with the 171 or more teachers in that •
number of schools, there are just that many more hands to give out or transmit education
in health, AIT the nurses of the provincial service have agreed that this is the one
way that school work can be done in rural districts in order to get the most out of it.
Health, the practice as well as the theory of health education is the responsibility
of the school teacher.
This is a project which should be given some thought and I would like to
investigate further to see what has been done in Detroit and in other centres in the
united States in relation statistics about the correlation of the screening of the
teacher and the nurse. This is one way that we could conserve the time of the public
health nurse In Canada and make for a far more efficient public health nursing service.
Child Health Program - Whether or not it is because the T.B. service has not been as
well developed from the lop as it has in Nova Scotia or whether or not there is a xfc&fitt J
strong belief that the nurse should be working with the infant and pre-school group,
it does remain that a gseat deal more is being done here in relation to child health
and many child health conferences are held, although most of those in these counties
are held in centres where there is a little more concentration of population. I am
told that in some of the areas they are right in the rural districts and people come
for many miles to them. One thing which was emphasized is that it is known in the
community that on such and such a day the nurse will be there. This is the same day ^ |
each month, (see statistical form for the conferences held in these counties.)
Shediack conference has just been open for three months and we visited the third
conference. The attendance was 50 new, 60 old. Of these 14 infants were under 6 mths.
these were not given immunisation* 11 were vaccinated, 110 immunizations were given.
This conference is held in the Canadian Legion Hall in Shediac*. Each of the
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n^rvInT1"?^ 5 T° gr°,Jp' (see notes in annual report). If it is
XioSy XZ for ™i™tU' thVSP°nSOring «""* wm *>***• *•* a-ange for
c^thfpLCet£       volunteers. They sometimes give sorae supplies such as oil-
IE ««M.?!+CSferBnC!i at ?tdiaC JS hold offioaUy ft'om 10 to 12 a.m. and 2 to 4 p.n*
2iJLf?ft2JT~ °n,  " 9#3° ^° 6 with ^^ a break for *■**• 0n the day we
«  » ,i* * !f!*W!re>J!rarses and 2 volunteers. This will not happen again since only
Miss Robadot wiH be left. She will however, have the assistance of the nurse from
another county. The nurses here, give the immunization. Miss McLagan gave all the
immunizations and the vaccinations during the day and the other three nurses conferenced.
In this area, and it is probably true in all the provincial conferences in New Brunswick,
the nurse weighs the baby and conferences with the mother while she is dressing and
undressing the baby and the conference may be continued after the mother has finished if I
there is time and if there is more to discuss. Asked the nurses about this, why they
did not have a volunteer to weigh the baby. They feel very definitely that the nurse
can see so much if she sees the baby naked on the scales and that it is much better for ,
the nurse to do the shole procedure. They would like it too, if this same nurse would
do the weighing, the conferencing with the mother and complete it by doing the immunization required on that day. Miss McLagan can cite many cases of defects which weuld be
missed if the nurse did not see the baby with its clothes off. For exaaple, there was
one premature baby which had a leg paralysis, which would have been completely missed
had they not had the mother undress the baby. There are rashes and other defects which
are often uncovered. This system has a great many points in its favor and after all it
does not take very long to weigh the baby. In the larger centres it would be necessary
to have more than one scale. They had two at Shediac, For a new conference with such
a large attendance the work was very well organized and the whole thing ran very smoothly ,
Volunteers had been told in the introductory conference that they are the
hostess. They are responsible for setting up the conference, seeing that there is heat, -
and that the place is clean. Sometimes they fall down on this. They pull the records,
put on the name and make out the immunization list and generally see that the clinic
functions smoothly. This seems to me to be the right attitt#£de towards the use of
volunteer assistance. One volunteer at Shediac is Mrs. Birk who was the director of
nursing for the course at Montreal University. She is a public health nurse.
Tuberculosis - All the follow-up work that is done outside of Moncton is done by the
public health nursing service. In Moncton there is a tuberculosis nurse sponsored by
the Gyro Club, She also attends the Dept. of Health clinic to which come many of the
cases, or rather all of the cases from outside. Miss McLagan feels that the public
health nurse of the district should be in the clinic when the patient comes in as this
a very important contact to have. There has not been to date too close a working
relationship between the Gyro nurse and the public health nursing service, but this is
being improved and cases are being reported better. All the positive sputum cases are
hospitalized except for those, I do not think there are many, who refuse. The nurses
patch test all children who are contacts. It seems that the general administration of
the tuberculosis program in New Brunswick is not at the same stage as it is in Nova
Scotia and consequently there has not been so much follow-up for the nurses in N.B.
Miss McLagan, however, feels that a great deal of the contact work can be done through
the general health education program in the schools and the child health conferences,   |
For example, one of the most important lessons given to the teachers is the demonstration lesson on tuberculosis. I am rather of the opinion that this is the function that
the public health nurse should play and perhaps less of the function of the.policeman
following up in the homes, as is so often the case. Miss Mclagan stated that probably  ■
20* of the work of the nurses in relation to tuberculosis is welfare. They make very
good use of the Children's Aid Society workers out in the county and in the city of
Moncton of course, there is the newly created Welfare Bureau under the direction of
Miss Reynolds* .jl
 -66-
S^SS^"*?1* T^1 h^i9ne teachin8 is ^^ntal in the homes, child health
hfLnr«f^ ^+4SCh°°i: ^6re are no Jollities and no testing facilties under
S! 2?^   fUGation. Mr. Chapman apparently, is able to give very good advice to
the teachers in relation to special mental hygiene problems. Miss McLagan feels that
■toe public health nurse is equipped to give the advice to teachers regarding any child
who is shy or who has a discipline problem, provided that the behaviour of the child
is not too anti-social.
Adult Health Education - The chief adult health education is in the form of Miss
McLagan*s contact with the teacher. When a new Home and School Association is formed
she is there to talk to them and she also gives talks to the Women's Institute.
She has been doing a very interesting piece of work with the Interprovincial
Home for Women, which a sort of reformatory home for women between the ages of 16 and fr
30. I believe they are there for anywhere up to four years. Every week during the
past winter she has been giving an hour of instruction. She has had to start with
very simple things and has discussed table manners, use of cosmetics, cloths to wear, -
etc. She has also shown films and given demonstrations.
Communicable Disease Control - Sanitary Inspector in each area does the placarding.
If there is a comwmicable disease in the school, the teacher will phone the nurse. If
it is one of the minor diseases she tells the teacher to exclude the children according
to the card. If there is any trouble, the nurse will go, and of course, if it is a
disease such as scarlet fever, the nurse will go immediately.
Immunization - the nurse does the inoculations and vaccinations in the child health
centre. In the immunization clinics which have been organized in each school to date,
the doctor has done the immunization. I do not know if this plan is to be continued
or not. The organization for the school immunization clinic has not been as good.
Here, the teachers do not seem to take any active part in the' organization of the clinic. They do send out the consent cards and make out the list for the immunization.
Miss McLagan told us that when they first covered the schools in Kent County which was
her first year here and also Dr. Landry's, before he took public health, no records
at all were made out.
Venereal Disease Control - This is included in the program for follow-up. In this
Act tho public health nurse is defined. She is not defined in the Public Health Act,
and it is stated that she is empowered to have any person whom she suspects as having
venereal disease examined. Apparently the present clinic is in the city hespital and
is a terrible affair. This will automatically cease as the patients can go to their
family doctor and he can be paid for treatment. It is very difficult to have delinquent cases reported from the city hospital as there is very poor cooperation in this
respect.
Sanitation - The system of sanitary inspectors is a very antiquated one in these
counties as in the most of New Brunswick. Apparently there are no trained men. In
Westmoreland county the nurse spends a lot of her time fighting with the sanitary
inspector over the fumigation of schools. They apparently do this frequent and for
no apparent reason. If the sanitary condition in the school needs reporting the nurse
would perhaps visit the trustees and she would also report to Mr. Chapman. If water
supplies are taken routinely as stated in the manual there would be a charge of $1.00.
Miss McLagan has not felt that she would be justified in pushing this as that would
take perhaps $200.00 of the special grant which is given for various services.
Staff Education - The public health nursing section of the Graduate Nurses Association
in New Brunswick for the area of Westmoreland and Cumberland County in N.S. which
brings in the Nova Scotia nurses association, hold regular meetings several times a
year in Sackville. All the public health nurses of the area attend and they have very
fine programes. They all find this very stimulating. In addition there is a
 -67-
conference in the spring and another in the fall in Fredericton to which all the
nurses go. (Notes from this may found in the provincial form).
Clerical Assistance - it is the policy of the public health nursing service of New
Brunswick to obtain partitime clerical assistance where such can be obtained. Miss
McLagan states that one-half of the time in the office could be saved if a clerk were
available. For some reason, I think it is a personal one, the clerk in Dr. Landry's
office cannot be used by the public health nursing service. They have tried the
services of one or two part-time people who have been recommended by the National
Employment Service. These however, have proved unsatisfactory. They are interviewing
one this week to see how she will work out. There is a terrific amount of clerical
work to do, especially in connection with immunization. When a child is immunized at
the child health centre a record of that is made in five different places. Suggested
the use of a card which would be a permanent filing card and would also save the making
out of the lists and the recopying of them.
Welfare * There are not many welfare workers. Miss Mcijagan apparently has been very
active ln the formation of the Welfare Bureau, which has only been going for the last
eight months or so. There are two trained workers in it and it however, is only for
the city of Moncton, although Miss Reynolds spends some time in the parish. In the
school survey which Miss McLagan did she estimated rather carefully, that 18* of the
cases reported represented welfare problems0 She made this estimate in connection
with the plans to create a Welfare Bureau and to point out the need for it.
 -68*
VICTORIAN omrep QF NURSES - MONCTON. M.,B.
™t%n^!S« lZ ^t thT t™  f0Ur nUrSeS Senres *• cit7 of Moncton only and does
J'L^^ of the suburbs. Miss Fowler who is the nurse in charge was away on
holidays and Miss Joy Clark was acting as senior nurse. Miss Clark has only been with
S^f^f f°Lone ?ef° !he iS a ^aduate of the Bachelor of Nursing course at
McGill University. I do not believe she has had any previous experience. The V.O.N.
service here is much the same as other V.O.N, services except that they operate a Baby
clinic once every week except one Thursday a month. On this Thursday, which is a regular
Baby clinic day, an Immunization clinic is held. Dr. Landry does the immunizations in
this clinic, A vaccination clinic is held twice a year with Dr. Landry doing the
vaccinations.
At the Baby clinic there is no volunteer assistance. There are two nurses, one
who does the weighing and some of the conferencing and one who does conferencing only.
The average attendance is twenty-five to thirty except in the summer time when the
attendance is rather low.
They did start pre-natal classes this last year, Miss Clark taking the classes.
They consisted of eight to ten lessons and when they started out there were quite a few
but the attendance dwindled down to four at the end. I do not know why this is except
that I would judge that Miss Clark might not be a very effectual teacher. Apparently
the doctors do not refer pre-natals. Most of the patients referred are referred by
themselves or a friend. They have twenty-eight pre-natals on their list now. They
average about three home confinements a month.
In relation to infants, they are all followed for one year for home visiting.
Dr. Landry is not on the Board of the Victorian Order of Nurses. A monthly
report is sent to Miss Hunter. This seems to be a hangover from the old days and there
is no particular reason why they send it to her*
The last morning in Moncton I visited the Tuberculosis Sanatorium which is
housed in one of the buildings formerly operated by the R.C.A.F. Miss Bartch is the
nurse in charge. There are 120 patients. In addition to the matron, Miss Bartch has
nine graduate nurses, one trained attendent and the remainder of the staff are nursing
aides . I asked particularly about the salaries. Graduate nurses receive $135 a month
gross. Trained attendants, $100 a month gross and the nursing aides, $80 a month, gross
The salaries for graduate nurses, considering that they have living-in is considerably
better than the salary paid to the public health nurses. Miss McLagan told me that her
cheque amounts to $94 a month. She, of course, has some deductions for her car, it is
impossible to get living outside for less than $50,00 a month.
In the afternoon went with Miss McLagan and Miss Robodot to their Baby clinic .
at Hillsboro, This clinic is he/kd in the Memorial Hall, They have a volunteer worker
who was a former public health nurse and a graduate of the University of Alberta course.j
They had 28 infants and pre-schools, 16 of these were vaccinated and 4 received inocula-f
tions. Miss McLagan did most of the immunization and she also did some conferencing.
They follow out the plan of the nurse who conferences, weighing the baby. This seemed
to be more of an immunization clinic than anything else and one wonders still if we are
giving enough to our nurses so that they can, in return, offer inducement to the public
to return to the Baby clinic for other than the immunization program.
 -69-
PRINCE EDWARD TST.AMnT
August 12th to August 19th, 1948 spent on the Island. As I had been here previously
following the C.N.A. and had met the nurses, they had had an opportunity to complete
the questionnaire forms which were left with them. These were done very excellently
and I have had an opportunity to go over them all with the nurses.
.      *  3ii addition to this and following our meeting, which was held in Friday
morning in Dr. Keeping's Office, I have visited with Miss Wheeler in her Summerside
area and have attended a Tuberculosis clinic in Summerside and in Charlottetown. I
have also visited the hospitals, the P.E.I. Hospital in Charlottetown and Summerside
Hospital and have had an interview with Mr. Shaw who is superintendent of education.
There is not a V.O.N, service in Charlottetown, although just recently Miss Hall has
been speaking to the Rotarians and they are quite enthusiastic about starting this
- service. The opposition to it comes from the  Dept. of Health. Miss Wilson feels that
there should not be another nursing service in the area, and if they wish a bedside
nursing program that extra staff should be given to them to carry it out. Miss Wilson .«
seems to put a great deal of emphasis on the school routine and although it would not
seem so from conversation, I believe that ±a actual practice that when other programs
are suggested there is considerable opposition to the interruption of the routine
school program,
A meeting on Thursday morning was attended by Dr. Keeping, Miss Wilson, Miss
Ross and Miss Wheeler. It was unfortunate that Dr, Shaw was away on his holidays.
Hone of the tuberculosis staff were brought in. There had been sorae misunderstanding
in that Dr. Keeping had the idea that we were to make a critical analysis of the
program. Perhaps that is why there seems to have been sorae opposition to our coming
although I had explained very carefully to Miss Wilson and her staff that we were not,
in any sense, doing an evaluation. I think the misunderstanding on her part, if there
was any, was inexcusable. I must say that I have had the very nicest rece/ption from
the whole staff. Some of them coming back from their holidays to see me.
As stated previously, the greatest emphasis seemed to have been placed on the
school program. The tuberculosis work is done by Miss Tate and officially, she is the
one who does all the follow-up. She does delegate some of this responsibility to the
nurse in the district but this has never been a definitely planned program and there
does seem to be some confusion in the minds of the nurses, I believe also, there is
some resistance on the part of some of them to carrying out this part of the program.
Miss Ross will not do it in Charlottetown nor does Miss Beer want to do it, Mrs.
Cameron has done a considerate amount because she likes doing the tuberculosis work and
Miss Wheeler is also anxious-to do it. At the present time there has been no system
worked out whereby the nurses have the records for the family. If
School program seems to be pretty much routine. They of course, cannot visit ,
all their schools during the year. I visited with Miss Wheeler, the one school in her
area. Schools are open early in the rural districts of P.E.I, because later on there
is a three weeks holiday so that the children can pick potatoes. This school was at
Cross River, there were 25 children from Grades 1 to 10. The school was not clean,
there was no running water and as we wanted to wash our hands before lunch it was
necessary for the children to go to a neighbors to get some water. No towels, no soap.
There were two rows of double seats. The teacher had not sorted out the children and
big ones were sitting with little ones. However, this did not make so much difference
because all the seats were the same size and fourteen of the twenty-five children were |
not able to reach the floor with their feet when they were sitting. Miss Wheeler spoke
about this and asked if they would get their fathers to make foot stools for them. This ,|
school had not been visited by the nurse for examination other than immunization since
1943# M<««»whMi«>»i»—lIhbkiw"fc"»» — tBfcuthwjmhildraw  First of all, Miss Wheeler
went over the records with the teacher checking the names with the register and eliminating those who had left school. She then lined the children up for weighing and measuring. The teacher recording the weight. There was no reference made to over-weight or
under-weight. Following this she tested the vision with the Snellon chart. The vision
 -70-
testing took exactly 45 minutes. Two children were found with defects. One of these
the teacher knew about and the child was getting glasses at the end of the week. The
second child had no obvious symptoms and was able to see the board quite well. The
defect was only slight and it was not felt that it was necessary to even refer it. Of
^LTw6    1WS aU this TOrk? By this time it was noon and as the women of the
district were coming to clean up the school in the afternoon, it was impossible for
Miss Wheeler to return. On her return she would no doubt, complete the inspection and
make out her report* I am sure she would also talk with these children about certain
obvious health situations*
While in the school I asked the teacher for the course of study in health.
She had to do considerable amount of searching before she found a rather tattered
course of study. The health curriculum occupied about two and one-half pages and is
as lacking in lie tail as the Nova Scotia curriculum is full of it*
Miss Wheeler and I went over to a beach near Malprfque for lunch. We discuss-1
ed the whole program then. She feels very definitely that it is much more important te.'
get into the homes and visit the infants and pre-schools than it is to do the routine
school work. She said that in Wellington, the doctor there has about 400/58nifl8ements
yearly. She cannot begin to see even the smallest proportion of the new babies. I
believe that birth lists are sent out from the Charlottetown office. She has not made
any effort to get names from Summerside hospital. However, I believe that cooperation
with the matron there is most difficult. Miss Wheeler feels that the school program
is given too much emphasis. The Immunization prgram which is carried on every three
years causes a considerable interruption and the rest of the program, such as T.B.
visiting, if any, and the baby clinics must be interrupted for this*
Miss Wheeler does her rural schools when travelling conditions make it
possible and spends the remaining months in the work in Summerside. There she has
800 children in what is termed the "high school" but is actually an elementary school
with grades 1 to 10, and 500 in the convent. Her program is to inspect, with the
mother present, all grade I children. Miss Wheeler is the only nurse who has made any
effort to have mothers present during the inspection. She also inspects the other grad
es, but does not weigh and measure them consistently. She stated, when weighing the
children in Cross River school, that she did not usually weigh the children in the
rural schools. However, it was one method of establishing relationship with the
children. She was not going in and immediately examing them for defects. There is
some poitt to this, although I do believe more and more, that this is the teacher's
function and the nurse goes in and acts as a consultant. That there is another wa/£y
that she can establish the necessary relationship with the children. Miss Wheeler
states that pediculosis is quite a problem, there is also quite a lot of scabies and
impetigo. Immunization in Summerside is done eaeh spring or else the children go to
their family doctor* There is a charge of 25tf for the three dorses and 10£ for the
reinforcing dose. The doctor gets remuneration by the hour and mileage if he uses his •
own car. They start immunization at six months and give a booster dose every year.
In relation to immunization, if the parent brings the child, this is considered as a
consent. In the town schools where the teacher does not know the parents, consent
slips are signed. But if in the country, and the teacher knows the parents, they do
not bother with a consent slip.
In relation to communicable disease, they do not seem to do anything. The
local doctor reports and placards*
Pre-natal work is only incidental*
Up until recently V.D.* has been a specialized program, but now the nurses
are carrying it in their generalized work.
On our first day in P.E.I. Dr. Baillie and I went to Summerside and talked
with Miss wheeler at her baby clinic there. She has a very nice set-up for it,
 -71-
^^^T^i7 t^7 tW° baMeS Were Present. The streets were lined with cars.
ILT^ 5£t HP     ? ^0mpauJ thiS With the sit«ation in Baedec. There is no doubt
?™\f\     3 relationship established in doing the pre-natal work is a very
important one and very helpful in the follow up*
In Charlottetown, Miss Ross carries the school program. Miss Ross had a
refresher course with Kellogg a year or so ago and she has been trying to incorporate
some of the ideas into the school program here. I do not know if she has met with
very much success. Copies of her material are contained in the files. Miss Beer
carries two of the Charlottetown schools and also has a baby clinic in Charlottetown*
Miss Ross goes to the baby clinic only occasionally. They are very busy, there is
very little follow-up work done in infant welfare. The greatest proportion of the
time is spent in the school program.
Prince Edward Island Hospital -* Charlotte town. ,
The P.E.I. hospital has 200 beds. There are about 65 students. Miss (Hair *j
is the superintendent of the hospital and Mrs. MacDonald is the Director of Nursing,
They have 13 so-mailed, head nurses. There are no actual general duty nurses as such* ,
The work is done by the students. The registered nurses having charge of the fleers.
There is considerable confusion in the educational qualifications in P.E.I.
Prince of Wales College situated in Charlottetown, at the end of two years they have
attained grade U and receive a junior matriculation certificate. But grade 11 from
Montague, Summerside etc., is not equivalent to the grade 11 from Prince of Wales,
It is equivalent to about a 10J- from Prince of Wales, as that is what one year at
that college is called and it is considered that 10J- from Prince of Wales is better
than grade U from the other schools. Grade 11 from the other schools gives entrance
to the junior Maritime colleges. An examination is written which is prepared by the
Maritime examing Board. In Prince of Wales, the staff there prepare their own examination and their graduates are qualified to enter McGill and Toronto. It is possible
for a student at Prince of Wales to take the two years in one and get the same stand- »
ing. Apparently the schools of nursing wish to take the grade 11 students from Prince
of Wales but they will also take students from grade 11 from the other schools. This
will not qualify them to take a post graduate course in any of our university schools.
In the legistered Nurses Act for P.E.I, there is no grade specified. In the P.E.I,
hospital they have the class filled for September and have some lined up for next
March's classes. Last spring was the only time when they had difficulty in getting
applicants and this year they have more than last. They stated that Summerside has
great difficulty in obtaining students. (Mrs. MacDonald is also president of the    L
R.N.A. in P.E.I.Qnd I discussed general nursing with her and with Miss fNair),
P.E.I, hospital had 18 graduates last year. Of this number only one is left
in the hospital. 15 have gone to other provinces, one has gone to U.S.A, and one got ?
married. They do not feel that it is salary or working conditions which causes this
exodus. The girls just want to see Canada, They take "The Canadian Nurse" and they
apply for positions before they are finished. The salary for the graduate nurse is
from $110 to $115 a month with full maintenance. The night supervisor receives $160
a month plus full maintenance. They work 8 hours on a broken shift. They are off
every second week-end, Saturday afternoon and Sunday and during the next week, they
have one whole day off and work Sunday. $25.00 is the allowance for maintenance as  »,
far as income tax exceptions are concerned. They have four weeks holiday with pay and
eighteen days sick leave, if required. No practical nurses are used and no nursing
aides. They have ward maids who do the dusting and sweeping. J
Miss McNutt who has just recently graduated from McGill in Public Health,
has been employed by the P.E.I, hospital since the first of Jugst. She wJl be.doing
general duty work on the floor and will look after the health program for the stude ,
 -72-
tt  ?n^o3!if h6alth S?Ca.i0? Snd ^ also taach some bacteriology. They would like .
S£j£iSrJE ST P^4  »6^ affiliation, but I did not feel that there was much
enthusiasm for this. Miss McNutt will get $125 a month with maintenance, this is much
better than toe salary of the public health nurses with the health department. Apparent
ly Miss McNutt prefers to work in the hospital, the salary did not enter into the consid
eration when taking this position. She is, however, very interested in V.O.N, work and
if a V.O.N, service is established in Charlottetown, will probably want to transfer to
al.
There is no referral to the public health department of any cases from hospit-
There is no affiliation for tuberculosis. ' |
PtBtIt Sanatorium - The sanatorium has 140 beds. In addition to the matron there are
11 registered nurses. There are 14 trained attendants. 9 of these graduated from the ,
San. last year, the other 5 are students. The trained attendants get from $70 to $80  i,
a month, plus full maintenance. The student attendants receive from $35 to $45 a month,
plus maintenance. The course for the trained attendants is two years. At the end of  >::.
which time there is a graduation ceremony with pins presented. Miss McClellari^ admits
that it does not take two years to train these poeple but it is one way they have of
holding them. She feels they do very effective work. At the present time they give
hypos and even streptomycin, although she admits that this is not desirable. They do
the housekeeping as well as the bedside care. Miss McClelland^feels that the ordinary
registered nurse will not do a teaching program anyway and that by using trained
attendants, the teaching program is not necessarily suffering. The lack of affiliation
for the student nurse so that when she has completed her training, she wiH know something about tuberculosis, is one of the  basic reasons why it is difficult to get registered nurses in sanatoria and also why an adequate teaching program is not carried out.
She states that her graduate nurses who are  in charge of floors, will very frequently,
do bedside care themselves. It seems that she has great difficulty in getting it over
to them that that is not their job.
Miss McClelland, says that the nurses want a broken shift. On Sunday they have
9 - 3 or an A.M. or a P.M., and in addition have one day a week off at 10 o'clock.
Every third week they get a ten off on Saturday and have all day Sunday. The nurses
get $105 a month plus maintenance. Miss McClellariii, said that in discussing the nursing
problem in Sanatoria with other San. matrons, who were at the C.N .A., it seemed to be
quite general that the nurses preferred to work in a broken shift,
Erince County Hospital. Summerside - Mrs, Boehner, matron. Ihis is a sixty bed hospital
and Mrs, Bodhner says there are eighty patients, approximately and in addition, about
twenty beds for newborn babies and sick babies. I hoticed on the maternity floor that .
there were extra cots in quite a number of the rooms so that conditions are very overcrowded. In addition to Mrs. Boehner there are fifteen graduate nurses. The supervisor j
is in charge of the floor and her assistant is called the head nurse. There are twenty-
five to thirty students. Mrs. Boehner would not admit that they are having difficulty
in obtaining students. The majority they take are from grade 11 in schools outside of
Prince of Wales. Graduate nurses start at $90 a month and are raised after the first  I
year to $100. The supervisor starts at $110 or rather $120 and the head nurse at $110.
They work six days a week and prefer the bpnken shift, they have amonths holidays.
There is one nurse aide on the staff and ward maids, they are not using practical nurses,
They do use a practical nurse as a special only. There is no affiliation for the      r
students in Communicable Disease, Psychiatry or Public Health. Mrs. Bodhner is looking
for someone who would be qualified to be a director of nursing for the school. She says
she has an instructor, a nurse who has not had any special training in teaching or
supervision, but who was a former school teacher.
J
 -73-
y^Sl^y " A*U?dTl *• ^thly clinic at Summerside. Dr. Creelraan examined the Patients who are brought in by appointment and fluoroscope. X-raying is dona
S?.J^°?S 5^ **£**  rl9 tW° nUrSes present at the <*****•    *is* feeler, whose
district itisand Miss Tate who does the special T.B. work. At the clinic the duties
seemed to be divided as follows - Miss Wheeler, met the patient, weighed them and had
them undress in the cubicle, pulled the files and took new history whan necessary and
attached a sheet to the records, putting on the name, age, and weight. Miss Tate,
completed the notes for the doctor on the attached sheet. She sat in with the doctor
in his room. She later went with the doctor to the hospital, where x-ray films were
read and took notes for him.
These records are then taken back to Charlottetown for typing and the records
are returned to Summerside at the next clinic. Miss Wheeler, therefore, does not get
the information before this. She cited examples where this is very inconvenient.
There was one new case, a child. The mother stopped Miss Wheeler on the road and
talked with her about the case. This was the first she knew about it. In another case
she went into the home and found a very ill baby. This was later diagnosed as tubercul
osis. Miss Wheeler was not upstairs there was a man with an open case of tuberculosis,!
It seemed to me that Miss Tate is merely being a clerical worker for the
doctor in this clinic,
pRecomendations
1. That there be a more completely generalized service, the nurses doing the T.B.
£ollow-up in the home.
2. The reports go to the nurses at the same time they go out to the doctor or the
patient,
3. That Miss Wheeler attend the clinics in her area and that other nurses attend the
clinics in their respective areas.
4. A part time clerk be engaged in the Summerside office. She would be for Miss
Wheeler and would take the notes at the clinic, and also could go over to the hospital
and take the notes there. She would then complete the records right in Summerside.
5. Miss Tate would not attend these outside clinics when the district nurses did.
6. That there be a medical social worker on the Sanatorium staff for the welfare work.
Saw Miss Tate in the Charlottetown office. She went over the books that she
has to keep for the annual reports for Ottawa and for the San., also the monthly report
for the Welfare. There are four books with the names of all the patients (out) are
listed. In some places they have the diagnosis, the municipality responsible, the
examinations, mobile unit etc. This is purely clerical work. Miss Tate states that
she spends one-quarter of her time on clerical work, one-quarter on welfare, one-
quarter on clinic and home visits, and one-quarter on travel and miscellaneous.
Venereal Disease - Miss Cox, until May of this year was employed as the special nurse
to do venereal disease work. In addition^ to taking her public health nursing course
she took the special three months refresher course at McGill in venereal disease     £
nursing. However, the last year or so, the number of cases has fallen off so greatly
that there was very little for her to do and she became very fed-up with the work and
so was transferred to generalized service. She still is a channel through whieh the
eases are referred to the nurses in the district. She attends the Summerside clinic
once a month and sees the new cases. Miss Cox completed a very nice Job analysis form
and has stated her ideas there. She feels very definitely that nurses need social
Jl
 -74-
STmeScaf sSal ^^"^Ji"6*86 W°rk « a ^eat deal of ** c<"*d * done by
^se^buf t^r^nte a LV^,rdinary °aSe wa,ta out TOy v*11 »ith the public health
nurse, but the minute a difficult one comes along then all the skills in interviewing
that are available are needed. It i<* th«n +>,«+ +v,« JZZ   u -.fu    m interviewing
-gs * "u ^"O11 that the public health nurse feels at a great
j^1^ R^ Cros8t PI?tIf Mvi"1fla - Miss Arsenault is the Commissioner here. Miss
Darrach is the nurse whose chief duties are in relation to the crippled children program.
There is also a nutritionist, Miss Haines and two or three other workers. The Red Cross
branch here is very active.
The Crippled children's work is quite extensive. Dr. Acker comes over from
Halifax about three or four times a year. He sees all cases referred for examination.
Sometimes he may do the work in the P.E.I. Hospital and sometimes they may be taken over
to the mainland for surgery. There is no orthopaedic specialist in P.E.I. At the preset
time the Red Cross have 250 cases on their records. These may be referred by the doctor,
the public health nurse or by the parents. They also have a part-time physio-therapist,
she holds corrective clinics at Charlottetown three times a week and in Summerside, every
other week. There are sixty children now reporting at these clinics. Last year, the   *
Red Cross sent $12,000 for orthopaedic and also for the supplying of glasses and tonsill- |
ostomies for needy children. Any child in P.E.I, who needs glasses and cannot afford to
get them can get them through the Red Cross, and any child needing a tonsilectomy can
have this done. The doctor contributes his services and the Red Cross pay the hospital.
Miss Haines, the nutritionist, has been working on a school lunch program. She
has had good results in fifteen schools and recently has learned of ten other schools
who have a hot lunch program. It is really a supplement to the noon meal. She is also
available as a consultant, but not has not been used very much by the Health Dept. I fear, ■
In addition to the crippled children's program, Miss Garrett has also organized home nursing classes. She had one last year and hopes for more this year. They have
now four loan cupboards, one in Charlottetown, one in Summerside, one in Hunter River and
en Pine Valley. With the exception of the one in Summerside, these are looked after by  i
volunteer workers. There seems to be a very great demand for the material which is
available on loan through these loan cupboards. Miss Garrett feels also that there is a
great need for bedside nursing service.
In relation to follow up visits on the crippled children, Miss Garrett herself
seems to do this. There does not seem to be a referral back to the public health dept.
Dr. Shaw. Superintendent of Education - Dr. Shaw explained the Grade X and Grade XI
schooling at Prince of Wales and in the other high schools on the Island, It is very
confusing. Previously to last year there was no full year of professional work for
teacher training. This has now been instituted. Pupils who come in to Prince of Wales  i
have had Grades 1 to X in rural schools. The first year at Prince of Wales is not the
equivalent of Grade XI, it is really X plus or 10J- as it is sometimes referred to. The
second year gives them Grade XI standing, which is junior matriculation. This will
enable them to enter any university in the Maritimes and also any other university in
Canada. It is almost equivalent to Grade XII which is required for other universities
but they are accepted anyway. It is also possible for a student so desiring, who has
$5% or over when they enter, to take the two years in one and thus write a special
matriculation examination. In the other high schools on the Island, the students take
only oneyyear beyond the Grade X which is taken in all the public schools. They write
the maritime entrance examination, then are eligible to enter the universities in the
maritime provinces. They are really very weak students on the whole because it is very
difficult to give the background of Grade IX and X ten subjects in the rural schools.
In relation to teachers training, those who come to Prince of Wales, take the .
first year, the second year would be a straight academic year which they take Grade XL
 -75-
^SSor^^secoi/v ^IZ 3eC°nd 7ear "■* **  th° teacher training year. On
SfrJirst c?asr«L«^ V*£ th&7 r8Ceive a 3econd class certificate. In order to
ft P^in^ of £1L    l^flZ**  ^ mUSt hSVe a fuU matriculation, that is two years
at Prince of Wales, and then, the year of teacher training*
oww J w^! Ml,apd *sland ^^as one hundred or raore new teachers each year in
E2ML S^ vacancias and meet the needs of expansion. The last few yeaJs they
have been training only fifty or sixty and now nn*  need raore than double that
number*
n    a    rr 4 ^f*1***011, *° e?trance for schools of nursing - the girls who have taken
Grade Hin the schools outside of Prince of Wales are eligible to enter schools of
IT8???,^ ^J1*?6 ^ard Island and may become registered* They would not, however,
be eligible to take post graduate course outside of the mVtritimes* The nurse who
has had her full Prince of Wales would be eligible would be enter a university outside
the a\aritimes. Dr. Shaw feels that we are right in requesting a higher standard for
nurses but he states that universities are traditionally slow in changing their
entrance qualifications and feels that perhaps there are some subjects which could take,
which would be of more value to them, but which are not yet acceptable as qualifying
'them for entrance to the university*
 -76-
Setpember 16 and  17th. 19^8 - Victoria
On the afternoon of the 16th met with Miss Frith. Both Dr. Amyot and Dr.
Taylor were away. Completed key information form.
On the morning of the 17th met with Dr. Amyot and Dr. Taylor and Miss Frith.
There was no Consultant Committee formed in this province. At the meeting with the
group, they stated that there greatest problem was lack of personnel, especially doctors.
The great need was to develop health units and this was being hampered by the lack of
« ^JJ'!011?81^ ?!? is n0t nearly as great a shortage of nurses in this province.
Miss Frith feels that if she had ten more nurses she would carry on very nieely at the
present time. Plans for the future include two teaching centre units for all personnel,
plus a number of others for nurses. Dr. Amyot feels that the public health course in
British Columbia should turn out a minimum of 80 public health nurses for the next five
years to meet the need and expansion in British Columbia. This year they only obtained
four from a graduating class of thirty-five. Apparently a great many went to the U.S.
We heard quite a long discourse on the advantages of a uniform for public
health nurses. Apparently all the nurses like it very much and there has been no
difficulty in getting them to wear it.
It was arranged that we would go to the Central Vancouver Island Health Unit,
with headquarters at Nanaimo for the next week, and that after a week in Vancouver we
might make a call on the doctor in the North Okanagan Health Unit.
Central Vancouver Island Health Unit
We were in this unit from Monday noon to Friday noon,
the following -
Monday afternoon spent with Miss Priestly in the office*
My observation included
Tuesday, in the morning we went to Duncan and I went out with Miss Morrison, the nurse
there* On our return in the afternoon we called at the Ladysmith Chil^d Health Conference and then went in to see Miss Peters at her home in Yellow Point,
On Wednesday we all went to Port Alberni, there I want out with Miss Beattie who has
recently been transferred from Armstrong,
Thursday I went out with Miss Dangerfield in the Nanaimo area and in the afternoon saw
the child health conference in Nanaimo,
Friday morning returned to the office to clear up the remaining points with Miss Priestly
Friday afternoon, returned to Vancouver,
There are eight districts in this Health Unit. In all there are eleven nurses
and a supervisor. The central office is in Nanaimo, Before the health unit was organized there were nurses in some of these districts. In Nanaimo, Duncan and French Creek
Districts especially. The service was organized along a bedside nursing idea, and very
frequently the older members of the community will harp back to tikis and want an lncreas-,
ed bedside nursing program. They, however, are never able to show a definite need for
it. Miss Priestly believes that the need is more for a visiting housekeeper service.
When the hospital insurance program is introduced and the chronic cases are discharged  1
from hospital, as is stated is going to be done, there may be a need for an increased
bfdside nursing program. At the present time the nurses give a demonstration program
although there are very few cases done* If there is this need, it is anticipated that
the Health Unit will take the load until they find out exactly what it is going to
mean. Rather than bring in a V.O.N, service they would prefer to add registered nurseiB
 -77-
^J^^rLn^883 *! Sf8ir 8^f- ^^ *"*• has been an agitation for V.O.M.
ST^tJSi!^11 2* "^ *obertson has been over talking to the people. They do not
know exactly where they stand at the moment.
fuxilaries - Miss Priestly has organized auxilaries in some of the various districts.
There is one going in Nanaimo and one in Duncan at least and I believe, one in Port
Alberni. These seem a very useful adjunct to the health unit nursing staff. The
nurses attend all the meetings and arrange an educational program for them, they also
have outside speakers. As a general rule the members of the auxilary represent sorae
organization in the community and therefore report back. This an excellent means of
lay education. There is a union Board of Health and as yet,the auxilaries are not
represented. Miss Priestly hopes that each auxilary will be able to send one representative to this Board. The Board meets every three months.
Manuals • the manuals are prepared from the provincial office. There is really no
general policy manual on public health nursing as yet but there is a reference manual
which includes many of the policies which have been sent out from time to time.
School program - This area last year spent most of its time, as far as the school
program was concerned, on the Wetzel Grid, They disregarded all former routine and
concentrated on the Grid, Children were weighed and measured by the nurse. Apparently
before last year, the weighing and measuring had been left to the teachers and when
they came to plot the Wetzel Grid they found that the weights were very far out in many
cases. They have, therefore, concluded, that the teachers cannot be trusted to weigh
and measure the children. However, I do not think that this stands. The teachers, if
impressed with the importance of the accuracy of the weights and heights, would certainly be able to do it as well as the nurses. As far as I can make out, before doing the
Wetzel Grid, it was the policy in most of the areas in the province for the doctors to
examine Grades 1, 4> 7 and 10, and the nurses to inspect all other children. They had
been cutting down on routine class room inspection. Miss Priestly says they do not do
any of that now. However, when I went out with two of the nurses, they both mentioned
that sometimes they did a routine inspection. In going out with Miss Dangerfield in
Nanaimo, I noticed that her routine was to call at the schools and visit all the rooms.
She makes a visit to the school once weekly. She would ask the teacher if there was
anything she had to report. Sometimes there was and sometimes there was'nt. The
teachers apparently were quite aware of those with eye difficulties. In one of the
class rooms a little boy, when the nurse was there or just as the nurse was leaving,
stated that he did not feel well. The teacher did not refer him to the nurse, she took
him back to the cloak room and sent him home. This may or may not have been the right g
procedure. It was, however, rather interesting. Miss Dangerfield announced to the
teachers that next week she would be back to do the weighing and measuring of the
unsatisfactory cases, since she thought that they were going to continue with the Wetze!(
Grid, at least for the Grade l's and the unsatisfactories. This program has not been
definitely decided as yet and so there routine of school work is rattier in abeyance.
On my visit with Miss Beattie in Port Alberni she did a routine inspection oi
the classroom and found two skin conditions, one scabies, and one impetigo. On our
return to the office we discussed the importance of this. Miss Priestly insists that .
the nurses do not do class room inspection and the argument was - how important was it
anyway to find these two cases. There seemed to be general agreement that it would
not have made much difference if they had been missed and the teacher had not referred »
them. The teacher was the one who should have been alert and referred them to the    e
nurse. However, I do not think that Miss Beattie has impressed this upon her teachers, 1
either in her former area, or that she will in this without sorae guidance. She is one I
who had been following routine. She stated to me that she thinks back to what she saw
in her field work practice, this was in Ontario, and that is what she tries to follow
out in her area here. No doubt Miss Priestly will give her better guidance.
School.
In Nanaimo in my visit with Miss Dangerfield, we went to the North Ward
There is one very ancient school of four rooms. It is so old that there are
 -78-
^/Z/00^^ ^ lavatories* How^ar, she is hoping that this will be corrected
* J t+ t?o k t  Same gr°Unds *ere  is a very modarn school which has just been
2f?\J  ^   u fOUr TOT'  excella^ lighting and excellent facilities, running
water, etc., in each room. The children and teachers are all delighted, and as one
teacher said, it gives quite a lift,
J4 ^ *£ the records of the class are kept in the unit office in their books which
are distinctine of the British Columbia provincial service. This means that as far as
schools are concerned, the teacher makes out a list of the children and thenurse takes
this to the office and either sorts the records herself and gets them in order, or gets
the clerk do it, I rather suspect that the nurse does it herself. This means a consider* \
able amount of work. It means also that the teacher does not have any record at the  " . j
school. The nurses are supposed when they visit a school to take the records along with i
them. However, they do not cart the heavy books as a general practice.
Mr. Alfair, the principal in Duncan mentions the fact that the teachers had no
records at the school. They have the progress records and he found that the teachers
were not using them so developed a system whereby the records were kept along with other
material in each class room. It would seem that there should be some space on these    i,l
records for "health information so that the teacher has something in addition to the
progress and the intelligence of the child. The high school program is a somewhat modi- |.
fied elementary school program. Nurses call regularly and immunization program is also
carried out. I dot believe believe th£ nurses are used very much for counselling. In
the school program, the nurse does seem to approach more the consultant idea. I noticed
that Miss Dangerfield checked on posters for the teachers and said that she would bring
them along. This type of health service seems to be a much better one than the routine
work which is carried on in some places.
The child health centres are quite well developed. I notice they have not yet
given up the  title "Well baby clinic". In some of the very small areas they may be held
in private homes. If the nurse can gather together ten mothers she feels that it is much
better to have a child health conference than to take, say, two afternoons at home visiting. The nurses in Nanaimo especially get the lists of discharges from the hospital
weekly, and they visit every case. They apparently, are able to do this. Also a birth
list is sent from the Victoria office every week.  As a rule, however, the nurses have
visited previous to this. There are not many requests for demonstration baths. In
some of the child health centres they use volunteers and in others not, depending on the
size. The routine is very much the same as ln all child health centres. One nurse does
the immunization in the larger ones, in the smaller ones, each nurse does her own if there
is More than one nurse. In their conferences the majority of questions the mothers ask
are in relation to diet. The nurses will add to the diet and they might add to the
formula. They would not change it unless they feel the mother would not go to the doctor,
I do have a feeling however, that perhaps the family doctor is not considered as much as
he should be. For example, when visiting I noticed that Miss Beattie arranged with the
mother to come back to give the immunization in the home. This is quite correct procedure if the mother cannot get to the doctor or if she cannot get to the clinic. I did
feel however, in this case that it would have been profitable for the mother to come out
to the clinic or even to her doctor. In this case there was no mention of her even
asking the doctor about immunization.
In the small clinic which I observed in Ladysmith the nurse did not have it
arranged too well for conferencing. For example, the mother was standing. Her literature
was over on another table, this consisted of the provincial and federal literature. In  i|
the Nanaimo clinic there was no literature of any kind. However, all the mothers have
had "Canadian Mother and Child" and they have also been receiving the infant and preschool letters monthly from Victoria.
There is no set policy in relation to follow-up visits, that is the frequency
of visits to infants and pre-schools. I think that if the baby is being brought to
aM
 -79-
^fthho^4e^re thSre *! nv follo,™P *» the home. They would however, follow-up
^2^\?J5  there seems to be a need. Miss Priestly feels that the pre-school
program is not wall developed. It, as is usual in raost places, seems to be that in
between period when there is not much done. Miss Priestly would like to get study
groups going for the pre-school group*
Pre-Natal - There are very few pre-natal cases refered by the doctor. There does not
seem to have been very much done to try to impress the doctors with the contribution
dhlch the public health nurse can make to the pre-natal program. Hiss Priestly feels
that if the nursing group would list their contribution and would try to sell this to
the doctors as a service they can use, as they have used other services. She, however, -
has not yet convinced the M.O.H. of this procedure. There seems to be here, as In other ]
places, a reticence on the part of the M.O.H. in educating the private practitioners
in the community. Miss Priestly feels that the particular contribution which the nurse
can make is because she has the time, she can -
1* Show the mother, through visual aid what the whole pregnancy means.
2. She can prepare the mother for breast feeding. $■-■ I
3. She can prepare the mother for the care of the infant. i
4. She can help prepare the other members of the family for the reception of the baby.
There are probably many other things which ate if a group got down and worked on it
could be worked out as the contribution of the nurse, I think that this is a very great
need at the present time in the pre-natal program, because it does definitely seem to
be one of the weaknesses.
Tuberculosis - I visited with Miss Dangerfield one case of tuberculosis. Apparently
tuberculosis is not too great a problem. Most of their cases are hospitalized and there
are a very few waiting. Miss Dangerfield says very definitely they are much better
patients after they return from sanatoria, as they learn there the meaning of rest
especially. They teach the patient isolation, precaution for all active cases.
Venereal Disease control - de nurses do a case holding and a case finding program.
Since there is an Epidemiologist who will visit on need and a well organized staff
education program, the nurses do not seem to feel so lost ln doing a venereal disease
program as they have in many places. The answer seems to be staff education.
Staff Education - This carried on through a monthly staff meeting. This lasts for about
four hours and at this meeting matters concerning policy and administration are those
chiefly discussed. Then there are the stu$y groups which also meet once a month.
Usually on a Saturday from 11 to 1. Each group decides on a project and when the
project is completed it is frquently sent to Victoria where it may be printed and
distributed throughout the province if accepted. Tais adds an incentive to the nurses, \
There is a North Island study group and a South Island study group. Miss Fiate? told
me in relation to the study groups that every nurse in the province is attached to one.
This involves a considerable amount of travel time on the part of some but I believe
it is considered well worth while.
The following is a copy of the memo which the M.O.H. has written for the nurses in
regard to immunization -
•This grants authority to you to perform immunization procedures, including smallpox
vaccination from this date until further notice".
Miss Priestly has designed a box to carry the child health centre equipment
for those child health centres which are set up each dav and may be held in the
 -80-
irholL^hr^JL18 l^en SUit Case made *° order' Parted black on the outside.
2r lit J£ il^ld  lfCh are «ollapslble, the plastic cover, the turkish towelling
illJSt  Pif JSTi!??un ?*?rilijser or P^, and has a pocket'for literature and
lilt™ iJi\E; chiid+health centres the nurses are supposed to wear their white
aprons over their skirt and blouse. It was noticed in the Nanaimo clinic that they
were wearing their complete uniform and no apron.
Supplies are not sterilized for the immunization, only the needles and syrin- '
ges. For inoculations they cleanse the arm with Zephryn, 1%.    For vaccination they
use green soap and then acetone. For the patch test they use acetone.
It was stated many times how much the parents appreciate the mothers advisory ;
letters. They are very pleased to have them also come on the day of the babies monthly i
birthday. They like specially to see if their child has reached the stage of development as stated in the letters. This is the first province that I have been aware of
the use of these letters. They are sent out by the clerks and are not of' any work for
the nurses.
In relation to the welfare program, where the services are developed as they I
are in British Columbia, the problems of the nurse are much less. For example -
compare British Columbia with Nova Scotia, where it was stated that one-half to one-Mdb •
third of the spent on tuberculosis was spent on a welfare program by their problems.
All the nurses in this unit are graduates from the U.B.C. course, except
Miss Beattie who took the course in Toronto some two year*ago. There was also a new
nurse who arrived the day we left, she had just completed her course at McGill, the
degree course and was from Regina. She said that she had written to the employment
service in Edmonton but that she had received no reply. Knowing that they are short
of nurses in Alberta, this seems rather strange.
VANCOUVER
We spent the week of September 28th in Vancouver visiting the following - Metropolitan,
T.B., V.D., Placement Service,Registered Nurses Association and U.B.C, also V.O.N.
and the Normal School.
Metropolitan Health Committee - The first day in Vancouver we had a meeting in the
afternoon with Dr. Murray, Dr. Pallen, Dr. Willett, Miss Hunter, and for a part of the
time Dr. Gundry. We discussed the various problems and procedures in relation to
public health. Dr. Murray and Dr. Willett were very gullible. Dr. Murray was more on
the defensive than I have ever seen him. There was considerable discussion of the
school program and routine physicals. Dr. Murray thinks that these are important.
One of their greatest difficulties is shortage of medical personnel. Some
of the reasons for this are stated that the program is too routine. They have no
imagination to see what they can get out of it, low salaries, and not enough presitfee (
for this type of public health work.
In relation to dental staff, Dr. Pallen says there is a shortage, the reason
being low salaries and that many dentists dislike children's work. Also in relation to
the dental program, Dr. Pallen stated that 40 to 45* of the children go to their own
dentist - 40 to 45^ go to the school dental clinic, and that each year fewer and fewer
of the lower grades are going to the school dental clinic and more and more to the
family dentist.
In relation to nursing, Miss Hunter has her vacancies all filled, although
two weeks ago she did not know which way to turn. She states that nurses like to come 1
to Metropolitan, they have heard about the program and are interested and they know
that there is good staff education program and good supervision and nurses want this.j
 -81- ~9Sh-
k„™ M  hS relati°\to general training of public health nurses, she feels that they
have not had enough about the normal child, or enough on mental hygiene.
* „  4+We discllssed physical exaninations at some length. Dr. Murray feels that there
is definite value in this but we could not get either Dr. Willett or Dr. Murray to give
any really good answers in relation to the value of the physical.
.  *  ^^ T  ** the Week' met with "i33 Hunter and Miss Henderson to complete the
key information form. The following is some additional information. Through the
Federal grant they are getting extra unit clerks, hoping to have one more in each unit.
This new clerk will take over all the extra clerical work of the child health program
which has not been done by the wolunteers. They will also do some school recording such
as making up the immunization list, x-ray notices, etc. Where possible, this work will
be brougit to the unit to do. The reason they do not like to take the clerk to the
school is that this year, school stenographers have been made a little more available to
the nurses and they do not want to lose this service. The nurses also will dictate home
visits and home reports in relation to T.B.
The family welfare operate Visiting Homemaker service for their own cases, that-
is for clients needing family case work. There is a great need for this service for T.B.
cases. Through extra money with Metropolitan now have available, they are going to tfcy
to work out some scheme with the Family Welfare whereby they will pay for the visiting
housekeepers and homemakers used for T.B. oases. At the present time, for T.B. cases
alone there is need for ten homemakers, sixteen housekeepers and there are nine to ten
situations where there is need for some hourly help.
The co-ordination with the hospital is improving. All Paediatric cases going .
to the O.P.D. are referred. This was started by Dr. Patterson and he now has all the
paediatricians doing this. There is also referral from Children's Hospital and from
staff cases in infants.
In addition to the Job analysis School questionnaires, etc., Miss Hunter is
going to have thirty nurses report on conferences with five mothers each. This is in
an endeavour to get the questions asked by the mothers and to try to serve as a guide
to the Information which nurses need to know about the normal child in conducting conferences both in child health centres and in the home. I will try to get this same information from nurses in other cities.
Normal School - Dr. Willet, Miss Hunter, Dr. Baillie and I discussed the Normal School
program with Mi3S Maxwell, Miss Maxwell does all the health teaching, which consists
of about twelve class room lectures and in addition there are half a dozen or so special
lectures for the whole group together. These latter were questioned, kxfc as there seems
to be some over-lapping, and it was felt that that time could be used better by Miss
Maxwell. She stated that if she had that extra time she would use most of it for visual
education - a subject on which she seems to be a bit hipped. Miss Maxwell also has a g
Normal School program and she carries out a demonstration service. However, in discussin
the work with Miss Maxwell, it was very apparent that she is not getting over to the
teacher that they are responsible for health. She does not, or she has not, realized
this herself. She tells the teachers what they will do if there is no nurse, that is if •
they are in a rural school and there is no nurse available readily, and ±£xxk what they h
would do say, if they were in the Metropolitan area where there is a nurse. She is not I
putting the responsibility onto the teacher. I was definitely disappointed in this part
of the Normal school program. Miss Maxwell also has a health service for the Hormal
School students. Dr. Will*t}being the doctor.
A
 -82-
SS^t^lf ^reI" Di3^3ad V.O.N. program with Miss Creasor. I do not
think that she is altogether sold on any amalgamation with the official health agency.
She feels that especially in the larger cities, the voluntary effort is necessary and
that with close co-operation, as there is in Vancouver, there is a minimum of overlapping. I am inclined to agree with her. I was very infttrested in the parent craft
classes which Miss Charters is conducting pre-natals. They have an attendance of
around 10 to 16. Classes are operated continuously and I think there are eight lecture.
for each group. Miss Charters is going to list the questions which the mothers ask
at these classes. I hope that this might be some guide to the information which nurses
need to know, in order to do home visiting to pre-natals and also conduct group teaching such as this. In relation to pre-natal referrals, the situation seems to be much
the same in Vancouver as in other places, although perhaps not so acute. Doctors are
not referring a sufficient number of cases. Miss Creasor said that nurses come in
from other areas and are impressed with the fact that mothers are going to the doctors
in Vancouver much-earlier in their pregnancy.
Tuberculosis - Had a conference with Miss Paulson. Discussed chiefly, the teaching
program on the wards. Miss Paulson gave me a complete set of the literature which
they have for each ward, and an outline of the teaching. The nurse in charge of the
patient is responsible for this teaching. Through a well developed staff education
program I think that the work being done here is very fine.
In the Vancouver Unit they have 34 ward nurses and 16 attendants or nurse
aides. In Trmnquilte there are 25 ward nurses and 40 nurse aides. This dilution is
too great. The teaching program suffers, also the patients are more insecure. They
feel that they do not see the nurses often enough and they have a greater fear of
something happening to them if the nurse is not there. The attendants wear a white
hoover uniform and no cap. An important feature of their program is that the graduate
nurses know how to use the attendants, they know what their duties are. This is
extremely important in introducing this group into the hospital service. They are
taking only students from the practical nursing course and from the former T.V.T.
It is very definitely felt that the teaching in the hospital makes the public health
nurses work easier and also makes the length of stay in the hospital less. The nurses
like this teaching program as long as there is time and they are not too rushed by
other duties.
In the T.B. clinic there is a public halth nurse in charge and her assistant
is also a public health nurse. Miss Paulson rightly feels that the other duties in
the clinic are only on the staff nurse level as there is actually little opportunity
for teaching. t '^Zm
The social service worker visits the wards on referral by the nurse to the
doctor. She does not visit all cases, only those referred.
All workers are on an eight hour straight shift. This is very much appreciated. This did not take extra nurses, just a little re-arranging^ for instance, they
took half the nurses off night duty and replaced them by aides. They have one month on I
night duty and one month on evening shift at a time.
Venereal Disease Program - Conference with Miss Beattie who is the nursing supervisor
at the V.D. Clinic. According to the new V.D. Act the local health services are     i
responsible. Howevere, in Vancouver, because of the size of the city it is felt that '
there will always need to be some specialized worker. At the present time, they have
epiddmiology workers, these are public health nurses. There is a staff of one supervisor, Miss Beattie, seven epidemiology workers in Vancouver, two epidemiology workers I
for the rural areas. There is also one male worker in Vancouver. In the rural areas
these workers act as consultants. In Vancouver they are actually carrying out the
program. The Metropolitan nurses are doing a case holding program on select cases.
Just recently, one of the Metropolitan nurses has been placed in the V.D. clinic. She
interviews and picks out for visiting. Cases she picks out are those where there is a|
 -83-
definite address and where it is quite a straight forward case. No doubt there will be
!!fe ^"^a/ases referred as the program grows. The male worker is experienced in
the services in social case work. He is not a trained social worker. He visits the
married men particularly. They try to give as much information as possible to the
nurse in the district. They first refer by telephone and then the record is sent. The
nurses follow up those not coming for treatment and those named as contacts. They are
really very selected cases. There is one social worker and she sees only those cases
referred to her, (See copy on file)of type of cases referred). In Victoria and the
rural areas the public health nurses do all the visiting but there it is a smaller
program. The following is a summary of the job of the epidemiology worker -
1. (a) Interviews each new case before diagnosis
(b) Interviews each case after diagnosis, gives an educational talk on the value of
reporting regularly, what Is required of the patient. Contact history is taken
also,
2. Each worker has patients to follow up according to diagnosis. They follow up by
letter, phone call or visit,
3. Visiting of contacts,
4. Each worker is also able to relieve in the treatment clinic.
Miss Beattie will be willing to send any information or have the nurses make
out any job analysis, etc., which I would like in order to have supporting information.
My talk with her emphasized the principal that public health workers are the first
jwesrhers in this program and the social workers are used as consultants. It might be
possible to get supporting information for this if necessary.
In further discussion with Miss Beattie, she said the public health nurses
do not seem to have much idea about business methods, for instance, filing, correspondence, etc. For example, they will send in letters with more than one subject in each
letter and this has to be copied off in the office.
University of British Columbia
Spent Wednesday afternoon with Miss Mallory and Miss Morrison going over the
questionnaire for the Rrovisional Council Committee,
In relation to the merit system unit of the American Public Health Association
they are not able to use this at the University on account of the cost. The pre-test
would be two dollars and the final test probably would be three dollars.
We discussed the question why do nurses take public health. They felt that
it was to get away from the hospital. There' is too much pressure there and the hours
are longer. They also feel that the nurses find through public health, an opportunity
to mix with community groups. This is not so easy in hospital work.
In relation to the nurses from the last class going to U.S.A. this seems to
have been quite erroneous information which was given by Dr. Amyot. They thought that ^
only two nurses were thinking of going and they were not sure if they had both decided j
definitely. Of the class of 35, Metropolitan obtained 15. The Provincial 4 and many i
others returned to their former occupation in other places. II
Placement Service - Discussed the shortage question in British Columbia with Miss
Braund. Since dte June the vacancies have averaged 310 to 325 per month. In 1947 the
average was 386 per month. Of these, the public health vacaAvies listed - Provincial
8 to 10 public health nurses, and 3 to 4 R.BVs. V.O.N. 5 public health nurses.
M
 shift.
-84-
Miss Braund feels very definitely that nurses prefer the straight eight hour
Thejmraay be some older nurses who are reluctant to give up the split shift.
Registered Nurses Association - Asked Miss Wright why the nurses are coming to B.C.
She feels very definitely that is the personnel practices which have been well advertis-'
ed in the Canadian Nurse. Another reason is climate. At least once a weak there is
an ad. for nurses pointing out that the R.N.A., B.C. agreement is in effect. There has
been an increase in the number going to the tftiited States. Miss Wright does not have  '
very much information in the use of the assistant nurse. She does feel that in some of
the hospitals they are heavily loaded. The largest majority of the nurses coming in are
from the prairies. The R.N.A. of B.C. have agreement with 0 hospitals and two public
health nursing groups. But nearly all of the hospitals have accepted the policy.
They are now working on the idea of a centralized school at the University of
British Columbia, They also are hoping that the preliminary class students can be
given their preliminary period at the University, This would be for all hospitals.
The practical nurse course i£ functioning and the is at the Technical School
which will be the new Vocational School. They are taking 20 every three months. First !,
class will graduate in December, it is a one year course and it is hoped they will be
placed through the R.N.A.
J
 -85-
October
NORTH OKANAGAN HEALTH UNIT
^L.1^- " We 3t°PPe(i off in Vernon to visit this health unit. Dr. Best is in
charge. There are seven nurses. Two of the nurses are situated in Vernon as well as
the senior nurse. There is one nurse at Armstrong and area; one in Enderby and area;
one in Salmon Arm and area and one in Revelstoke and area. The total population is
estimated at about 35,000. There is one Sanitarian and one more to come. They have
a sub-office in Salmon Arm at which there is a clerk, as well as the clerk in the
Vernon office.
We discussed the program throughout the day. Dr. Best is quite young and
very intense about his work. In relation to the school program, they are swinging
away fron the routine examination of grades 4, 7, 10. He is trying to do all of grade
1 with the parent present. He seems to be making an effort to see the principals and
explain the program to them and gain their co-operation in doing this, Miss Denyforce
said that they do not weigh and measure the children. They test the eyes every year
and they do a physical inspection on all the children. They do not do any routine
class room inspection unless in a rare case of communicable disease. They usually
do not do it for communicable diseases.
In the towns of Vernon and Armstrong especially, where the former service
was a school service, they visiting the schools e^ery day. They are gradually trying
^yfco get away from too much school work. Some of the rural schools are visited once
a week and others once a month. The nurses may have as many as 13 schools. The
greatest travelling distance for the nurse in any area is about 25 miles, except in
Revelstoke where it is greater and the population less concentrated for the two or
three areas which she visits, which are more distant.
There are child health centres in various centres.
annual report was obtained and this gives the listing.
A copy of the last
In relation to pre-natal work, Dr. Best had contacted all the doctors. All .
but two have said that the public health nurse would be of value. They, however, have
not followed this up and not doing very much pre-natal visiting at the present time.
There is very little, if any, bedside nursing and hardly any demonstration work. As
a matter of fact, there is no bedside nursing. Very little demonstration bedside
nursing and very few demonstration baths to babies. We had a very enjoyable day
I starting out in the morning about 11 O'clock and driving down Kalamalka Lake, this
means lake of many colours. We drove up the Coldstream Valley for a very short
distance. Then after lunch we drove to Enderby, where there is a sub-office, but it
is not at the present time, being used because the nurse lives in Salmon Arm. Dr.
Best is questioning whether or not an office is necessary here, especially since there
is a clerk in Salmon Arm and as it is only 15 miles away it seems wiser to have the
nurse use that office. I am inclined to agree with him in that point. From Enderby
we went to Salmon Arm where we met the statistical clerk and also Miss Stone, who
has just come to the provincial service after three years in V.O.N, in Vancouver. She .
says she likes the work very much and likes Salmon Arm much better than Vancouver.
Miss iony&rce told me that Dr. Best did most of the V.D. work. They
really have very few cases, 1
In relation to T.B. it does not seem to be a very great problem. Each naa'jj
nurse has very few cases to supervise, m
m^mtmZ^yJLL I
Left Job analysis and.School questionnaire for Miss Donyfloroe and Miss
Willins to collate. Miss H^^t took her public health at U.B.C. eight years ago
and Miss Willins took hers at U.B.C. about three years ago.
complete two forms.
They are each going to
 -86-
CALGARY
Arrived in Calgary at noon, October 5, 1948.
II ^ - ]+  ^ afternoon went to the City Hall and reported to Dr. Hill. This is
^tVZu    rlt^/i  ^iaii^ services. Visits here included observation and conferences
w ^ ^8n w   Rreiene olinio nurses, School nurses, T.B. which is under the Kinsman Club,
The  Child Hygiene clinics were started in 1923. Miss Laval was sent by the
Provincial Government to organize the clinics. At that time the school nurses were all  -
under the School Board. In 1935 they came under the Dept. of Health, but still doing
the specialized services.
Miss Laval started with four centres but now they have only one at the City Hall
The reasons given for not continuing the four was that they did not have cars and equipment for them, cars to travel to the clinics. They twice tried branch clinics, but one
petered out through lack of customers and other got so large they could not keep up with
it because of insufficent staff. In any case it was out of the city at Bow Nest and the I
people there could not afford to finance it. The present eentre is on the third floor
of the City Hall. It functions in the morning and in the afternoon, although the afternoons are the main sessions. They have a doctor four afternoon a week. The mothers who
come in the morning- are chiefly those coming for inoculations.
There are three nurses in addition to Miss Laval in the Child Hygiene clinic
program. All of these nurses have had public health, two of them are degree course
nurses from the University of Alberta. (Note further on regarding observation in the
clinic.)
The nurses visit the homes. Each nurse has a district. The birth registration
card comes from the Vital Statistics Dept. Following receipt of this, a card is sent to
all the mothers and fcfr»jp»i»ntM^»»iiwi»»iLii^ii.t.Un>ni the doctor is also circularized. If the doctor returns the form saying that it is a good home, nothing further
is done by the nurse. If the doctor states the home is poor or a fair home, the nurse
fellows up. Most of the doctors return the letters. They try to persuade the mothers
to come to the clinic. For those mothers that come to the clinic before the visit they
make one follow up initial visit. If they do not keep on coming they call again after
the baby is six months old regarding inoculations. This is called the follow-up visit.
All the birth registrations are filed in the office. At the end of six months all who
have not come to the clinic are circularized regarding immunization. When the child is
between three and four years old, whether he has been to the clinic or not, they are
sent a definite appointment to come for an examination. There seems to be a good response to this. If they do not hear from this, the nurse will visit, especially if it is a
child who has been previously to the clinic. If they have never been to the clinic they
may not visit and they would not bother if they are living in a good part of the eity.
Every pre-school child gets free ear, eye and nose, and throat treatment, except hospital
expenses and the glasses. Every pre-school child gets free dental treatment. A dentist
is paid by the city and gives a certain amount of time. Appointments are made by the
nurse. When they have finished with the pre-school examinations the records are handed
over to the school service* B
"The Canadian Mother and Child" is given to those who come to the clinic.
They also receive a 24 hour chart and after the baby is over a year old they get the
weight scale. The parents are very interested in this*
They do not use volunteers in the clinics,
(infant goes up to the age of 2 years in Calgary).
In 1947 there 1,681 new infants
 -87-
/n.<u tj .-iJJ ^4 ^/ory difficult under the present circumstances to cooperate the
Child Health clinics into the generalized set-up, as Miss Laval feels that there is
nothing like a specialized service.
_,«. *u Ji!?6? iS J8*** from the Ganaral Hospital for one month. She spend this
with the Child Hygiene clinic, chiefly weighing babies, and out of this time two or three
days are spent in observation with other agencies. There is not a very good understanding
of the properly organized student program.
In addition to the work with the Child Hygiene clinic, Miss Laval also inspects
the private hospitals. There are about six of these. There do not seem to be any
standards for licensing. The hospitals which care for the chronically ill and convalescent are licensed by the Provincial Dept. of Health. Those caring only for aged and
infirm are licensed by the Provincial Dept. of Welfare. It is not necessary in either
institutions to have a nurse in charge. Miss Laval also inspects and supervises the
boarding homes of which there are about 39. The Children's Aid Society have one home
which is used for neglected children. Miss Laval does all the visiting. She also is
responsible to investigate patients who apply for free insulin. There are not very many
of these*
Contagious Disease Department - Miss Watt is in charge of this department. Her chief
duties are the inoculations and collection of vital statistics. She now has a nurse
assisting her. The inoculations are done from 9 - 10 in the morning and 3 - 5 in the
afternoon. They are quite conservative in the type of antigen used in that they are still •
using diphtheria and whooping cough separate. They have not used any of the triple antige
She considers that if fifty children come in for immunization, it is a busy day. I think
Miss Watt also follows up if there are any reported communicable diseases. There does
not seem to be a very close correlation with the other departments. Miss Watt also does
the tuberculin testing for the schools and the inoculations at the city Creche, Dicks and
Schicks at the hospital for the students. The city provides her with a car.
School Nursing Service — Miss Dean Freeman came the first of August as the supervisor of
the School Nursing Service. Previous to that there has not been a supervisor. She has
ten nurses, seven of whom have public health. Miss Freeman herself has had public health
at the University of Toronto in 1932 and has had considerable experience with the V.O.N,
and army experience and quite recently completed subjects for a degree at Wayne University. Part of her credits were taken in an industrial nursing course. (See notes later
on conference with school nurses and visits to the school.)
Tuberculosis Association - Mrs. Curry is the nurse employed by the Kinsmen for the T.B.
Association. The clinic is held next to Dr. Hill's office. There is a clinic every
Wednesday afternoon when the doctor cooes from the San. They give a tuberculin test.
Patients may be referred by the doctor, they can go to the San. or the General Hpl. for
x-ray. I am not quite clear which group comes to the Kinsmen. Mrs. Curry does follow
up in the homes for contacts, etc. She may only visit once following discharge from the
San. If they do not return for the x-ray she will follow up. There are no individual
records kept. I do not think that Mrs. Curry has had public health and neither has
Miss Watt*
Venereal Disease Clinic - This is headed up by Mrs. Harvey who is a R.N. She has the
territory from Red Deer to the border. I believe that there is some arrangement for a
clinic at Lethbridge. The treatments are all done by Mrs. Harvey and the two nurses.
Bloods taken, smears, etc. Mrs. Harvey does the individual interviewing. Apparently
noji referrals are macfe to the nurse on any other staff, even out in the Health Units and
ln the Districts, Patients all come into the clinic and the work being done by Mrs.
Harvey and her staff. There certainly is no attemtp at generalization of the service..
J
 -38-
..,   _ _
S^SSS °2TifaSS5* "+^S iS a fiVB nUrse agen°y- "i38 B- Richard is the nurse
St^^ThftJS addition to her supervisory duties she also has to carry staff nursing
£?£!:» ISM£«  . !u8gen?? *" ^^ased tremendously since two or three years there
has been an additional three thousand visits. They are now waiting for their sixth nurse<
One of the outstanding features of the program here is the extensive pre-natal health
supervision and also post-natal. The Associated Clinic in which there are five doctors
doing obstetrics, three full time obstetrics and two doing the occasional case, refer
Tl JrT^  Ca8eS ^ the V'°-H* Jt seems toat about six or seven years ago the idea   '
of the V.O.H. service was sold to them, presumably by the V.O.N, and since that time they
have been using the service extensively. All but one of the doctors offers to the mothers two demonstration baths on their return from hospital and they pay the V.O.N, for
this service. There are so many prenatal cases referred that the nurses have not time to
visit them all, and sometimes only make one pre-natal visit. Other doctors, not associated with the clinic also refer their cases. The V.O.N, have a little difficulty lest
the feeling be prevalent that they are working for the Associated Clinic. Another
feature is the very popular pre-natal class. Miss Richard conducts the class, she makes
it more of a discussion and not a formal lecture. She has not taught pre-natal classes
before, but I imagine she has a gift of leading discussion and getting over the material, .
also stimulating the mothers to talk and ask questions. She says they do ask a great
aany questions. One of the dairies gives them milk and chocolate milk and/ifee^o^JyStta
buy cookies. Following the class they sit around and have refreshments and more discussion takes place naturally.
There is a minimum of overlapping here. They discharge the babies at six
weeks. Miss Richard says the city clinic is very popular, but there is need for branches J
to be opened in other parts of the city because Calgary's population has increased so in
the last few years. Miss Richard attends the meetings of the Council of Social Agencies, •
apparently Dr. Hill does not attend these nor is his agency represented. They have quite
a time getting over some of the stumbling blocks caused by him. For instance, in relation to restaurant inspection they finally got all restaurants inspected except those in
Chinatown and Dr. Hill said - "0 well, they are in the slum area". There apparently have
been a few other things which have caused them concern* i
For the size of the agency this V.O.N, service has a heavy student program,
both from the University of Alberta dad from the hospital. The nurses like to have
students with them apparently, and I imagine that the program worked out is very good.
Miss Richard has it in written form.
It was nice to talk to such an enthusiastic group and to find that the service
here is so popular. I regret very much that I have been unable to make any visits with
the V.O.I, nurses.
Home Visits - One afternoon from 1.30 to 2.30 I made sorae visits with Miss Reesor, nurse
in the child hygiene clinic. She had picked out four visits. She explained to me on    i
the way that they do the following types of visiting - (l) birth registration. If the
letter is returned from the doctor stating that the home is poor or only fair, the nurse
will visit, otherwise birth registrations are not visited. (2) a follow-up visit from
the clinic. If the mother comes to the clinic the nurse will make one visit in the home
to see the home situation. (3) visit at one year. They have a system whereby they put j
the names down in the black book. For instance, she will put Mrs. Jones on October 1948.,ij
In 1949 she will look back to Oct. 1948 notation, see the name Mrs. Jones, pull the card
and make that visit. The visite that she had picked out were - ||
(1) to an infant who had been coming for whooping cough immunization. There was also a
pre-school child in the home. (Correction) This child had not come for whooping cough
immunisation and the nurse was checking. The mother lived with her two children and her
husband in one small living room and a small bed room. There was no place for the
children to play outside. The place was clean and the mother asked the nurse to sit down
She said she would'nt. She covered a lot of ground in a very short time - flashing
1
 -89-
from one child to another.
i2) Jt*  TV*8"*8*8*1? 8 m°ther who wa3 supposed to be home with her new baby.
However, she had not yet been discharged from the hospital,
an eleven
(3) Visit to i .oath old infant living in arf hotel room with mother and father. They had
moved in from outside Calgary and had been unable to secure any better accommodation. It
was a very large healthy looking baby. The chief thing discussed here was the baby's
fear of being left alone when the mother left him. This is probably due to living in such
small quarters and having to be with his mother all the time.
(4) This was also a not at home visit.
Miss Reesor was most anxious to obtain my opinion and was difficult to explain
that I was not coming along with her in that capacity. She seems very anxious to take
a post graduate course and really/6§i8h supervision. She spent two years with the school
service before the last three with the child hygiene. Having taken her public health
course in 1942, she really feels the need of a refresher. She likes this service much
better than the school routine. She said she never felt part of the staff there and
never felt that she was getting very far. She wanted to know if she should sit down when
she went into the homes and I told her that I thought that was the one thing that I would
suggest, that public health was important enough for us to take time and the mothers to
take time to discuss it with them. After returning to the office she showed me the
records. There is very little notation on them. For example - when they make the birth
registration visit, the card is already made out in the Vital Statistics Dept. She would
visit, find the birth weight of the child and suggest to the mother that she come into the
clinic. There would be very little notation on the card of this visit. The fact that she •
had recorded the birth weight would show that she had made the visit.
Child Hwgiene Clinic - It has been stated previously the type of clinic and frequency.
The one I observed was the infant clinic as well as the pre-school clinic. The pre-
schools come on two afternoons a week through regular appointment and also appointment
according to time. The pre-schools were being taken in a corner by a window by one nures.
She weighed and measured them, examined their teeth and looked at their feet and filled
out the card. After this they were taken in to the doctor for their examination. She
explained to me that they also look at the posture and that the doctor also checks the
feet. They give exercise forms and he may give some special advice regarding building up
of the shoes. It seems to me that they are putting an awful lot of emphasis on this and
I wonder if they have the most up to date knowledge.
One child was objecting very much to being weighed and cried very hard. It was
impossible to weigh him and so the nurse let him go back with the mother and have another
attempt. I could not help feeling that the mental effect on the child was much worse
than not having his weight, he looked like a good husky fellow anyway. The interviews
with the pre-schools lack privacy. The mother and the nurse were both standing and
sometimes the child sat on the window ledge. There could be no possible opportunity for
discussion of any mental hygiene problems. It was purely physical.
The infants that were brought, were undressed by the mothers and were weighed
agf measured by the nurse at the desk at the table. On this day the registered nurse
who had been employed to help with the inoculations was doing the work. Usually the
student does this. She weighs and measures the child and writes this on a small slip of
paper. She then pulls the record and puts a number on it so that all mothers will be
taken in order and takes the record into Miss Laval. As the nurses are ready the mothers
are called in for conference, but not all mothers stay for this, only those who want to.
Sat in on one conference with Miss Laval. This mother was very much opposed to immunization. Miss Laval started in immediately to tell in a rather negative attitude about the
values of immunization. It was very evident that the mother was rather emotionally
disturbed about this. I would judge that she would probably be in favouy, but that the
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mother was not given any opportunity to talk out her
husband was very much opposed. The
feeling on the matter.
It would seem to me that this is a very routine clinic, although it is very
popular and the nurses have a great deal of leeway in what they suggest to the mothers.
There are a great many phone calls.While I was sitting in Miss Laval's office one mother
phoned apparently about a sick baby and advice was given over the phone. Although the
^f!iC^^r0°* ^ crowded the nurses did have a place to conference, except the preschool and there was that much privacy. I think that perhaps these nurses know their
formulas and diets for the infants and pre-schools very well but I rather think that they
miss out on some of the other problems that are perhaps just as important, if not more so,
There is no staff education. I did not see any evidence of up to date articles to keep
them informed of the newer developments.
School Nursing Service.- One afternoon at four o'clock I met with Miss Dean Freeman and
her ten school nurses. Three of these have not had public health, the rest are all
public health trained and are a very young and alert group. I explained the survey to
them. They had quite a number of questions but all relating to their particular job.
For example, one nurse was wondering how much time the nurses spend trying to keep the
children clothed. It turned out that she was very concerned because the children did not
wear stockings to school even in the winter time. It was not apparently any difficulty
in relation to finances. That is, the parents could pfford to provide the children with
clothing. We discussed this and wondered whether or not it is a very important public
health matter anyway. Another nurse was concerned because only four out of forty-four
children were brushing their teeth. Another wondered how much time she should spend on
health talks, she apparently gives a half hour talk to sorae of her classes about three
times a year. I tried to point out my feelings in relation to the responsibility of the
teacher and that it is the practical health teaching which should be done and not so much
of the theory. I am going to visit with one of the school nurses and will learn more
about their routine.
Went with Miss Robertson to Connaught School. This school has about five
hundred pupils, Grades I to IX. Miss Robertson graduated from the University of Alberta,
Public Health course in 1946. Previous to that she had experience in the navy. Miss
Robertson has six schools, one of them is as large as this, the rest is smaller. She
had a rather small medical room, called medical inspection room and most of her schools
have one. Her plan for that morning was to put the vitamin pills which come in large
cans into boxes which they sell to the children for two dollars per box. Hardly the job
of a public nurse. In regard to dental appointments, each nurse has a quota of children
to send. The dentists do complete examinations on every child during the year and the
appointments are made from these cases. Three-quarters of the children, she thought, go
to the school dentist.
Miss Robertson's own routine is to go to the class room once a week to find out
who is away and if they have a phone she will try to phone the mother. There does not
seem to be any effort made to have the teachers phone to find out why the child is away.
If there is no phone she will make a home visit if the child is away more than two days.
She thinks that most of the home visits are due to illness. If there is a clinical
disease, the case will be reported by the nurse to the Health Dept. If the case is in
the class they will examine the class about two times and instruct the teacher to watch
for symptoms. Teachers do not do any morning inspection. If the case is whooping cough '
the Quarantine Officer will placard. The teacher re-admits for all cases of illness
except the communicable diseases. The nurses do a rapid class room inspection the first
week of school and after Christmas. Doctors examine Grades I, III, V, VII and X. In
preparation for this, the nurse weighs and measures the children and records on a class
health record, The names have been copied on to this from a list which the teacher had
prepared. Onto this record goes the wight, the result of dmtal examination, etc., and
from this the information is copiedto the individual card. The nurse also has to copy
the information from the history sheet onto the new cards for beginners. Teachers do
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^th8^8id8,0f th8 f°rffi- F°r the grades which ^ doctor does not examine, the
nurse weighs and measures, tests the vision, looks at the throat, feet, etc. In
relation to health talks, they average between five minutes and ten raiiutes. They are
not planned before the nurse goes to the class room. She feels that they do not have
enough practical experience, especially to talk to Women's Institutes, Home and School,
etc. ' '
While I was talking with the nurse a child with a very slight case of impetigo
came in. Nurse gave the child ammoniated mercury ointment and sent him home. This
seemed quite unnecessary, there was no note sent to the mother or the teacher.
In relation to mental hygiene, there is a visiting teacher and a worker on the
school board who seems to look after mental hygiene problems. She has never referred
any to the Child Guidance clinic and does not know the workers in the clinic. The
nurse does not do any follow up. Miss Robertson feels that they have not had enough
mental hygiene. She says that she feels most inadequate when dealing with mental health
problems.
The school service in Calgary seems very heavily loaded with routine and the
doing of work which is really very ineffectual. It would seem from my casual observation that fifty percent of the time is wasted. Miss Dean Freeman will have a difficult
time to get rid of some of these routines.
Facility of Education. University of Alberta. Calgary Braneh.
Went at noon to visit with Miss Chittick who is the health teacher and nurse
at the above institution. There are over two hundred students taking education. The
course is two years in order to get a certificate but they may go at the end of one year
and get a letter of permit. They have to complete their second year either by taking
the full year's work or by taking three stammer sessions. If they are only going to take
one year the government will pay their tuition fees. The medical service includes
medical examination for which the student pays four dollars. The nurse does some preliminary work such as weighing and measuring, testing the eyes and filling out the card and
the students are then sent down to the Associated Clinic for which the college pays a
flat rate of two dollars. In relation to health teaching, Hiss Chittick has about 36
hours in the school term. She teaches first of all, factual material where necessary
and then teaches them how to teach health. In the curriculum of studies for Alberta
there is a definite statement about what the teacher is responsible for (See Course of
Studies). It is very interesting that this is so stated. Miss Chittick said that when
she goes out sometimes into the schools she will see the nurse working and they are
working quite apart from the teacher, and refer very little to her. She feels that the
nurses have no idea of what is contained in the Course of Studies. There is a very
definite need of correlation here.
Provincial Sanatorium. Bowness - In the afternoon went with Mrs, Curry, Miss Dean
Freeman to see Miss Connor. Free treatment has been extended to all T.B. cases in
Alberta. The San. has about three hundred beds. About thirty beds are ±nts± idle
because of shortage of nursing staff. Here they have about 24 displaced persons and
like them very much. A new group has quite recently arrived. The nursing staff consists,
of ten nursing aides who are licensed; four nursing aides who are just in training ahd
two who are going to become licensed. In addition addition there are four practical
nurses approved (this category includes former nursing students who have had to drop out)
they are more than nursing aides but not as much as graduate nurses, this is a special
civil service category). That makes 20 below the graduate level. On the graduate level E
there are three administration and supervision, 6 charge nurses and 18 staff, which makes
24 doing ward duties. In addition there are some part time, about the equivalent of 3
full time, so this makes 27.
program,
There does not seem to be any clear cut responsibility for the teaching
Miss Connor says that all are responsible.    They have not worked this out
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in quite as good a way as they have in British Columbia. (She Manual book and material
which is given for instruction to nurse aides, etc.)
J
 -93-
MEETING WITH ALBERTA CQNSULQ&nt'S COMMITTEE
On October ftth in Edmonton, met with Dr. Bow, Dr. Somerville, Miss Clark and Miss Evans.
Later on Miss McCulla joined the meeting. The major public health problems were stated
as -
1. Recruitment of well trained personnel
2. Insufficient salaries to attract and hold the personnel
3. Housing for the Health Department
4. Expansion projects under the Governments grants proposed, dental, industrial,maternal
and child health and also expansion of the Division of HeaSLth, Education.
They are short four nurses for the Health Units. Basic plans for the Health
Units seem to be one doctor and two nurses to sixteen to eighteen thousand population,
plus one half-time sanitary inspector. Dr. Soraerville feels that in Alberta, they do
not need one nurse to five thousand population. Dr. Bow does not agree with him in this
respect. Dr. Somerville feels that the/ present Unit plan is enough to carry on ax an
adequate nursing service. When asked what he meant by an adequate nursing service, it
apparently includes practically no bedside nursing. He said that they would give a
demonstration in communicable disease only. There is no pre-natal nursing supervision,
he said the doctors do not want this. Includes school nursing, communicable disease,
and t.B. Venereal disease work is all done by specialized workers and home visiting
in relation to these. It includes Child Health conferences and immunization clinics,
was
Miss McCulla/asked to state what she felt were the inadequacies in preparation,
and she listed them as follows -
1. Not sufficient social psychology - students get social case work only.
2. In adequate supervision of field work.
3. Need for greater practice in public speaking.
4. Lack of mental hygiene and basic psychiatry.
She felt that perhaps they get too much in their obstetrical course, 36 hours.
She wonders whether or not they should have bacteriology as they have in the Manitoba
course. During the discussion, Dr. Somerville agreed that a second nurse at the University for Field Work supervision might be obtained through a government grant fund.
In all, it was quite a successful meeting. There was sorae discussion also
in relation to medical personnel and the inadequacies of their training. It was definitely felt that the lack of a public health person on the staff of the medical school was
rather serious. It is during the basic medical training that recruitment for public
health can be carried on effectively, just as in the public health nursing course.
if
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RED DEER meAT.TO ttmt*
5! 2^wfn^?lth J^V*3 thQ °ne ^ich ~ chosan for us to visit. Dr. Week^s is
the Medical Officer in charge and there are two public health nurses - Miss Murray and
Miss Wright. Miss Murray took her public health course at the University of Alberta in
i?4 mJ?    4  ^\l,\H  ^ Prince Edward Island> took her course at McGill, 1946-47.
Dr. Weekes is a British trained doctor and has been in this area for a little over a
-Sikr.
^ is JT?eARed Deer He&lth Unit originally consisted of five municipalities. It is
now divided into two, Lopom*? and Red Deer and recently the Poplar Grove area has come
under the municipal district. The total population is around 25,000. From Red Deer
north about 20 miles, south 21 miles, the whole area is about 42 miles squase. There
are clinic centres in sorae ten or eleven small towns. The centre at Locomfc we spent the
whole day which actually amounts to about two hours in the morning and two hours in the
afternoon. The doctor goes to all the clinic centres.
The program seems to be largely a school and immunization program in so-callei
Child Health Centres. The district is not divided in two for the nurses and as it is
planned to have a third nurse and a fourth nurse before very long, I wanted to find out
what the plan would be in relation to districts. Miss Murray did not think they would
divide it. This shows a lack of system and supervision in nursing from the provincial
level. il
Child Health Centres - As stated above these centres are held in some ten towns. The
afternoon of October 12th one was held in Red Deer, which I observed.' The two nurses
were present. The clerk took the names of the mothers as they came in and also entered
other information in the book. The purpose was to count the attendance. From the clerk
the mothers went to Miss Wright who weighed the babies, they were not undressed for this.
Some mothers she did a little conferencing with, but it was never sitting down with thera.
Those who wanted immunization, which was the majority, went off to another room to Miss
Murray, Miss Murray, seated while the mother was seated, gave the immunization and did  !
any conferencing which seemed indicated. This, as is usual, related mostly to diet.
They do not use volunteer workers in any of their centres. In some of the smaller ones
there is only one nurse. Some of the mothers were sent ln to the doctor. These seemed
to be the ones that presented problems too difficult for the nurse, and also mothers who
might want to see the doctor themselves. The nurse would not hesitate to change a
formula if seemed indicated. The nurses were wearing their blue dress uniforms and no
aprons were put on for the clinics. I do not think they had any aprons or bags.
School Program - The doctor examines children in the school and all the children in the
small schools every other year and the nurse sees thecalternate grades every other year.
At the beginning of the school ter£ they draw upa p'flSe of the schools and build a time
table around this. This is also the way they do their immunization program and at this
time they wmax were conducting immunizations in the rural schools. In the winter time
they would do the immunization in the town schools. We estimated that about 48 public
health nursing days would be spent during the year on the immunization program. All of
this seems a great deal of waste of the doctors time. The next morning I went with
Miss Murray to the first two of the six schools which she was going to visit for immunization that day.
The first school had only eight pupils and the supervisor. All the children
were taking their work by correspondence. The nurse went in, set up her immunization   r
and did the children. A couple of mothers brought along the pre-school children. There
was no conversation with the teacher or nothing said to the pupils. The next school
where there were 25 children, the procedure was repeated. Neither the teacher nor the
nurse said very much to the mothers, of whom there were two with pre-school children.
In the first school about seven immunizations were given and in the second about twenty-
five. This contrasted very much with what Miss McClure of the Edmonton Rural Health
unit later told me about their program. In the schools they give only the reinforcing
 -95-
df !L™+^8 n^8\°\heT ^J* wU1 give the re-inforcing dose, will do the examinations
IL^SISSons which she is going to do for the year and will discuss any problems with
<l     *%!       I     T ^v? ^^^a ^om two hours to the whole day in the school, depending on the number of problems. At the Edmonton rural they have clinic centres throughout
toe area,  so the children are brou^it to them for their immunization. It is very hard to
know when the nurse is becoming a technician and when it is justified that she will carry
out the immunization. I certainly do not think that it should be done in such a routine
fashion in the schools as it is done in the Red Deer district.
In the first schools with a supervisor there were three Grade VIII girls who
were studying their correspondence work. I asked them about the health and they showed
it to me. There was a large chart for testing their eyes and also instructions for test- i
ing of hearing and a diagram in relation to arches. They were most enthusiastic about the'
course and said they liked doing the things which were suggested.
Tuberculosis - There did not seem to be a very good program in relation to tuberculosis.
I asked to see the records and was given an ordinary letter file. I picked out one case
of a young girl for which a report had been sent in 1942, she was then 15 and in school.
It was recommended that she stay out of school and that she be hospitalized as soon as
possible. The next report was 1944, and the note made that she was still waiting for a
bed. I asked Miss Murray who seemd to be in charge of the T.B. file where thegirl was
now. She said she was at home and I wanted to know if they did not have any follow-up
visit on her recorded. I had been told that the recording of the home visits was just
put on the back of the letters. On further investigation, Miss Murray did not know where
this girl was. They had no record of her ever having entered San. and there was no record
of any home visit. The whole T.B. prpgram seems a bit loose, like this. In their annual
report, of which there are two, in neither did the figures agree, there is a very low
record of visits to T.B. cases, and indeed, very few home visits of any kind.
Although, it is true that there are only two nurses to 25,000 people, I have a
feeling that they are not accomplishing nearly as much as in some of the rural areas in
the Maritimes where there is a little bit better organization of the work. It seemed to
me that the Child Health Centre was essentially a weighing and an immunization clinic.
Incidentally, they measure every child too.
Miss Murray has had over six years experience, most of which has been in Health
Units. She  has been in this Unit for about three years, and until last year was carrying
on without a doctor. Miss Wright has been here a little over a year. She has had
experience in the navy before coming to Red Deer.
EDMONTON RURAL HEALTH UNIT
While in Edmonton I spent a part of the day with Miss McClure who is the supervisor of the Edmonton Rural Health Unit. The doctor is Dr. Siemons who is on leave of
absence studying at Johns Hopkins. Dr. Gillette of the Provincial Dept. spend a couple
of half days each week with the Edmonton Rural Unit. I was very glad of the opportunity
to discuss the program with Miss McClure because they really do seem to be carrying out a
very fine piece of work. Dr. Siemens is apparently excellent on public reaitions. He has
built up a very fine program for teachers and conducts an institute of a month each
summer. This course costs as one university credit. It is called "Constructive Medicine"
The book containing the syllabus for the course is on file. .. j
The nurses here wear uniforms similar to the one in Red Deer. Miss McClure told*
me that they spend anywhere from an hdur to an hour and a half on home visits. Their
school program does not seem to be routine and there is an excellent relstionid^ip with
the teachers, although I did not have any chance to observe with the mn-ses, It^^J'jfl
it is probably very inch as she told rae. They have eleven immunization clinics throughout!
the area. These ale becoming raore and raore like child health centres and Miss McClure
A
 -96-
feels that more time should be devoted to them. However, it was definitely stated that
no policy was to be changed while Dr. Sieman was away and so she cannot make any changes
now. These really should be child health centres.
Their mental hygiene program is very fine. Mr. McDougall is supervisor and
spends a lot of time with the teachers. I also had an opportunity to talk with him. On
examination of the family roster I noted that there was a great many that had some notation
in relation to the attitude of the mother. This is the first time that I have noticed this,
It shows the value of the mental hygiene program in the daily work of the nurse.
Took fairly complete notes on key information form. No job analysis or school
questionnaires were left with the Edmonton Rural Health Unit as they were really not
included in our Study,
District Nursing - I had not realized that Miss Clark who was Director of Public Health
Nursing was not also Director of the Nursing Personnel of the Health Unit. As stated
previously there is not nursing supervision in the Provincial office in the Health Unit
areas. Miss Clark is now engaged on the Survey, and Miss Augusta Evans is Acting Director.
Hiss Emerson is her assistant. It was a very busy day when I had time for Miss Evans,
and there were many interruptions. !■ fa reiki aw The statistical information form for
the nursing and also for the Health Unit was left, and this will give a better picture
in relation to numbers, etc. I also collected the Manual and other information isolation to district nursing. Two of the nurses who were given Job Analysis exams have
returned them. Miss Evans will check and send me the other two.
District nursing seems to be very popularIwith a certain type of nurse. It
is really a treatment and preventive service. The nurses have cottages which are
supplied by the municipality and also their fuel and water is supplied, and if they
are popular, they get more given to them in fhe form of vegetables, fruit, etc., then
they can eat. The salaries are good; start at $1960.00 and go up in six years to
$2400.00. There is good supervision and direction from the Provincial office. A
news letter goes out every three months. They have a good record system built up.
During the war years when some Units were started with only one nurse, and
without a doctor, these one-nurse units did look to Miss Clark and Miss Evans for
some assistance, and they still do to some extent.
I think there are about 35 districts. They are short sorae six nurses.
Miss Evans has advertised, but so far has not had anyissults. When they start a new
nurse they are given three days orientation period in the office. There is a three
day refresher course once a year for the district nurses. The Health Unit nurses
cone in one day each year for a so-called refresher course. However they meet with
the doctors and other Health Unit personnel, and quite often do not get beyond the
discussion of how much toxoid should be given for immunization.
The district nurses wekk wear uniforms, blue and white, or rather blue with
white confer and cuffs. Any district nurse with whom I talked, seemed most enthusiastic about their work. They are the centre in the community. The people come
to them for help and when they do this they can get over a great deal of health
education.
Alberta Registered Nurses Association - Saw Miss Cogswell who is with the National
Employment Service, and Miss E. Belle Rogers. Miss Cogswell is at the present moment
an employee of the Registers Nurses Association, but on the first of November, will be
taken over by the National Employment Service. I talked with Mrs. Iyons who is head
of the Women's Division. She is very enthusiastic about having the nurse in that
agency. It is an experiment worth trying. I cannot see that the nurses are going to
loose out very much, if any,  and there should be a great deal to gain. For example,
when young girls come in seeking employment, they can be directed, if they have the
necessary qualifications, to Miss Cogswell. She has already taken several groups on
a tour of the hospitals. It does not seem to me that they have yet built up a very
good record to indicate vacancies. They reported to me 180, and yet they seem to be
 -97-
a great deal shorter than that. In the smaller hospitals, they are not yet using
nursing aides to the extent that they might be, and again, in some of the smaller
hospitals, they are using them far more than they should. In some places, they are
having them giwe hypos.
They are planning affiliation with TB starting in January, but not all hospitals end not all students will receive this. The maximum number which the San. in
the south can take is eight. So far they only have three slated. When the new San.
in the north is built, they will serve the hospitals in the north. At the present
time, nhmm there is no affiliation in psychiatric nursing. The association here is
talking about a central school, and hopes to get some assistance as a Gov't grant.
This however, is not a central school under the University.
Provisional Council - One afternoon had a meeting of the Provisional Council of the
University Schools of Nursing. Miss Penhale, Miss McCulla, Miss Clark, Miss Evans,
Miss MacQuarrie, and myself. We were also fortunate in having Miss Agnes MacLeod
present. We went over the questionnaire which had been sent to the University of
British Columbia, and the suggestions which they had made for changing it were incorporated. Miss McCulla will send the questionnaires to the other Universities
as soon as possible. I mentioned again that there might be some money available
if recommendations were made which would need money to carry them out and that if tiiey
were acceptable ones, it might be possible to soma of the Kellogg grant. No one had
any ideas although of what they might be.
Alberta is being rather hard hit as far as public health leaders are concerned. Miss Evans is being married the end of this year, and Miss Mcculla is leaving to be married next June. That means there needs to be someone brought in as
Director of Public Health Nursing, or rather Acting Director, and Assistant Professor of Nursing at the University, ^hese are two very important positions, and it
does not seem that there is anyone in the Province to fill them. There is really
quite a shortage of pubBphealth nurses in Alberta, when one considers that so much
of the Province is uncovered. Dr. Gillette has plans for opening of new Units, but
is being held up by a shortage of doctors. I do not think that he is going to
adhere to Dr. Summerville' s plan of two nurses to one doctor in eaeh Unit. I think
he will have a doctor generally supervise three or four such areas. He also has
excellent ideas in relation to the use of teachers. He would use them for a screening
I think, and certainly intends that they will be the workers in health education.
He did not understand what we were meaning when we talked about the public health
nurse doing pre-natal supervision. He understood the programme more in relation to
the nurse mid-wife. I thin^, however, he would be very receptive to our type of
programme in Canada, and would assist in having aaaaxmgxhhaxjiK the public health
nurse carrying out all supervision in pre-natal care.
A
 SASKATCHEWAN
October 18 - Meeting with Provincial Consultant Committee in Regina. Miss Smith,
Chairman. Dr. Doyle was present in the absence of Dr. Hayne, Other members included
Dr. Walkom, Miss MDonaI£,and Miss Story of the Junior Red Cross. When asked their
chief problems in Saskatchewan, they said right away lack of personnel - personnel
whether with or without training, and the lack of trained personnel was very acute.
The second major problem brought up by Dr. Walkom was the need for better facilities
for work. He waa referring specially to the facilities in his Department. He is
housed in the basement of the City Hall, and Miss McDonald and the nurses are up
under the roof. Dr. Walkom referred to Joseph Mountain's article on the housing of
Health Departments. (Might be well to look this up and read it). The third problem
was teaching the public what public health really is. There was a considerable bit
of discussion in relation to preparation of public health nurses. Dr. Doyle said
that they should have a different type of training. When I explained the 26 months
course, he agreed that MndDcaigkJDckicdtkaxksJdggxx?^ that probably would be the better
plan, and then the public health course after it.
they
In relation to public health doctors, Dr. WalioH felt that/must be educated,
they must be doctors, and they should experience.
It was brought out that they are trtlnlng approximately 34 nurse aides a
year under the C.V.T. training programme. There is only one centre at Saskatoon.
As far as I could make out in later observations, there is not a great deal of use
aade of nursing aides in Saskatchewan. This is perhaps too definite a statement,
however, for my limited observation, but it does seem to me that they could utilise
any more than the number they are training. My observations with the city Health *(ml*^
Department includedm discussions with Miss McDonald, 1 and Dr. Walton, meeting with <C.
the nurses of the Department, visits to a school with Miss Eddy, also a brief visit
to a school with Mrs. Heffener, and a visit to a well-baby conference. Miss McDonald realises that the school programme receives too much attention, or that rahter
that too much time is spent on the school work. The nurses weigh the children three
times a year. They also do a vision-testing of all grades starting at the kindergarten.  I discussed with her the need for gradually getting the teachers to take
over some of iiuoqo these practices. We learned that an in-service training programme
of the teachers ih Regina was being instituted, and emphasized the opportunity that
-this waa for the Health Department to do some real educational work. The course
of study for Saskatchewan includes health inspection under all grades, and the following is what appears; "Annual Examination: In schools where there is no permanent
\ medical or nursing service, the teacher is expected to make an initial health inspection during the early part of the first month of the school year. The following should be noted in respect to each pupil; History of past illness, immunization,
symptons of present ill-health, vision,- test by using a simple chart, A written
record of observations should be made. The co-operation of parents should be secured whan necessary to insure prompt af correction of remedial defects ."If this
is included In the curriculum, then Health Department staff are losing a big
opportunity to have the teachers carry out more of this observation.work.
One morning I visited Kitchener school where Miss Eddy is the nurse. Miss
Eddy is not a trained public health nurse. There are about 750 pupils, and this is
a middle-class area. Miss Eddy was doing routine inspection of Grade 8. The nurses
do these inspections of all the Grades each year. Miss Eddy's procedure was to have
two girls in the office at a time. The whole school had been weighed previously.
The nurse took the weight to the class-room. The teacher had already listed the
names on the class-room record, and when the nurse weighed she recorded it. Then the
nurse had gone over last year's chart and recorded in red the growth in height and
weight over the past 12 months. This record was then taken back to the cla8S-room,
was supposed to be gone over and posted by the teacher. Miss Eddy said, however,
she often found it underneath the blotter on the desk. She said that she weighed
the children or tried to weigh then, four times in the school terra. The procedure
te th7«^tio£ or inspection, in the medical room, was to have one girl come
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ap to the window, examine her teeth, tonsils, hair, etc., then the girl with one eye
covered, read the eye-chart. The other eye was covered, and she read the chart with
that eye.  It would be quite easy for the children to memorize the lines. The second
girl was sitting on tha couch right under the chart. Then the girl stood in tha corner
while Miss Eddy stood in another comer and whispered numbers. She whispered anywhere
from 12 to 16 for each ear.  Although it is the procedure in this school for the nurse
to examine the Grade 3, Grade 7 and Grade 9 and referrals with tha audiometer each
year, they still do the routine whisper test anyway. It was noted in the inspections,
of which about a half a dozen were done at the tine that I was there, there was no
mention made regard to diet, nothing in relation to posture or feet. There was no
opportunity either to counsel with the girls since there was always two in the room.
It seemed that health education was lacking, and it was largely a checking.for records.
The medical room was quite a large one, ax±x±fcxwwai±xfcrax£xxjmkBi adequately furnished,
but there was only one health poster. Nothing to make it really appealing from the
point of health education.
In that school there were two classes below Grade 1, a pre-klndergarten
and a kindergarten. Miss Eddy said that the school doctor, Dr. H»™mV> examined
Grade 8 first. The reason for this is so that they will avoid examinations in June.
When this was mentioned to Dr. Walkom, he said that he did not know that this grade
was being examined first. Then Dr. Hannah examines Grade 1. He does not examihe
the kindergarten. In relation to vision testing, they test the vision of pre-
klndergarten and kindergarten children as soon as possible. The reason given for doing
this was that two or three years ago a kindergarten pupil had a rather serious eye-
defect, and it was not discovered, so the kindergarten supervisor asked that *P
kindergarten children be tested.
Miss Eddy has another school,of about 400 attendants. She is at Kitchener
Monday morning and all day Wednesday and all day ftriday. Part of this time she may
be out in the district, but I mther judge that most of it is spent in the school.
She is at the second school, xaxm Tuesday morning and all day Thursday, Tuesday
afternoon is scheduled for visiting. She has a baby clinic on Monday afternoon.
She does a rapid Inspection in September only, and thereafter the teachers
are supposed to send suspicious cases.
Following observation in the school with Miss Eddy, I went on a home visit
with her. It was to a birth-registration visit. The nurses get a lis't, or Jockx
rather, they get a record of all the birth registrations, and they make an initial
visit. The V.O.N, notify them of any babies which they are visiting up to the 6-weeks
period, and nil overlapping is avoided so far as is possible. Miss Eddy made quite
a nice contact, the mother had had the doctor in that morning to see the baby, because
she felt that the baby was not getting enough from her breast. Miss Eddy left a card
stating where the clinics were , invited the mother to the clinic, and also left
another card so that the mother could send for The Canadian Mother and Child,
Another day visited a well-baby conference of which there are, I think,
six.held weekly in the city. At this conference there were two nurses, neither of
them had had public health. However, Mrs. Martin the nurse in charge, has had
considerable experience in pediatrics, and also has two children of her own. The
clinic was kin held in the basement room of the library. It was very bright and
light and warm. There was no private room for conferences. The mothers brought
the babies in, undressed them, and brought them to the scales to be weighed. The
second nurse weighed the babies, pulled the records. This was all that she did.
Then the mothers went to Mrs. Martin for conferencing. Mrs. Martin was very
enthusiastic about the conference method. Apparently they had not used it up
until a year or so ago. All the nurses have copies of the Metropolitan Conference
Guide, and these are liked very such. The usual literature, Federal Department,
was on the conference table. They do not use volunteers in any of the child health
centres. This is too bad, since it is very dull for the one nurse just to be weighing
the baby. I asked Mrs. Martin if they woi^^ke^turns. She pointed out that Miss
Jacksorf had just been with the Departa«mir&^^ ordinarily they would take turns.
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L^+^+Lf lhe W°?? ?0t flDd the ^i^ing ^ther dull after the conferencing and she
admitted that she certainly would,
+4    »,, A Ii5i\W^h Mr8° Heffel at another school did not lend much further information, Mrs. Heffel was reported as a nurse who is extremely interested in welfare
problems. One had a feeling in talking with her that the individual counted a great deal
and that perhaps the general public health might be overlooked in zealousy to care for
the individual and see that his problems were looked after regardless of whether or not
the parents would take the responsibility. Mr. Coates, the psychologist came ln while
we were tailing with Mrs. Heffel. I had seen him previously and he had explained the set-i'
up of the 6hild Guidance Clinic. He seemed quite enthusiastic, and he brougit out a
point, which I believe, is well taken, namely, that it is better to have a number of   J |||
psychologists, possibly under the supervision of a psychiatrist. That the psychologist
can make the approach with the teacher and examine the child first. The psychiatrist
seems to rather xxxxx frighten people. It is probably because of the association with
psychiatry. I think perhaps he has a good point there, in that many of the minor things
can be taken care of in this way and the psychiatrist's time is saved for the major
problems. At their Child Guidance Clinic, which is described in the key form, the
psychiatrist does not examine the childxmn. This psychiatrist is loaned from the provincial department. They seem to be doing a very good piece of work. The nurses are writing very good histories in spite of their lack of preparation and they are all enthusiastic about it. It was very gratifying to see how the public health nurses are brought in ,
to the mental hygiene program and how much they are relied upon for their reports of the '
child and their knowledge of him and of home conditions. • i
The nurses do not do immunization. At the Child Health Centres they are referred to the City Hall to a clinic which is open every day. A nurse there does nothing but
immunization. There is one clinic which is held in the school on Monday afternoon. The
immunization nurse and Dr. Hanna attend it. The immunization nurse, although she will
give the immunization at the City Hall, does not give it at this clinic. The theory
being that while at the City Hall, Dr. Walton is there in case of emergency and therefore i
when she goes out there must be another doctor. I think it would be a great saving and
make a much better service if the nurses gave immunization at the well-baby clinics.
Venereal Disease - is done by a specialized nurse, Mrs. Burns, she has not had public
and T.B.        health training either. She spends two and a half days a week at
the clinic which is held at the General Hospital. Practically all the tuberculosis work
is done by the Anti-Tuberculosis League. Their follow-up from the San. is done chiefly
by letter and through the family doctor. But if a case is delinquent in reporting for ,,JH
examination, they are then referred to the public health nurse or the police. Mrs. Burns
does the necessary follow-up in the city of Regina, that is, she follows up the cases
that are delinquent.
All V.D. contacts are reported to her and she follows them up and gets them to
come in for examination. This specialized service seemed to me to be rather a waste.
Dr. Walton and Miss MacDonald feel that they need two more nurses. One to fill the
present budget vacancy and another would be extra. I feel however, that if they utilized
the present nurses to the best advantage, and cut out some of their school routines they
would be very well off as far as numbers are concerned. They are handicapped in that only
Miss MacDonald and one other nurse, who is due to retire very soon, have had public health
training. Z ^M •
Dr. Walton said that they spend tan thousand dollars a year on milk for under
weight children in the schools, I wonder if this is money wisely spent.
Victorian Order of Nurses - There are two V.O.N, nurses in Regina. Miss Maddaford is the y;
senior. They have both had public health training. It is rather surprising that, in a  i,
city the size of Regina, there are only two. They do not seem to be very busy. Miss
Maddaford says that there are one or two nurses with the V.O.N, in Prince Albert and I
 -101- '^
think a couple in Saskatoon.
/* ™ « +^Sir T>re"n^Al Program is very small. Up to the end of September they had only
H FTSfS ^88kV4   ^fg^tared births up to that time were 1,175. They are seeing
about 22% of the babies after they come home from hospital. To date they have had 270.
These are seen at the request of the mother or doctor. They visit every seven to ten
days until six weeks, then they are advised to go to the well baby conference. In order
to avoid over-lapping with the Health Dept. they send a list of new babies that they are
calling on. I do not think the V.O.N, have made much effort to contact the doctors to
have them refer their cases. Miss Maddaford said that 15% of their total visits are to
chronics. They could carry a heavier case load. Their student program consists of
taking two students each week from the Gray Nun's Hospital, Each student has only one
day. Not all the students will get this service. The nurses from the Rfgina General
do not have any public health observation or experience. Miss Maddaford says that the
students who have been out with them often follow up and enquire about public health.
The V.O.N, also give two hours a week to industry.
Provincial Health Department. - While in Regina I had some interesting conferences with
Miss Smith, Director of Public Health Nursing. I was amazed to find so few of the nurses,
on the staff of the provincial department were public health trained, the vast majority
have not had any preparation. Miss Smith does not feel that it would be wide to set up
a course in Saskatoon. She feels that Saskatchewan cannot afford to support it and would
be better to send their students either to Alberta or to Manitoba. From my observations
in Alberta, it is quite probable that they could take extra students from Saskatchewan.
I was amazed to learn that the majority of the students in the Alberta course are degree
course students. Their numbers fluctuate from 16 in 1941 to 23 in 1948. Next year they
expect from 15 to 16 and there iM»ttfcki««*ggtn»ti;Mff are very few who come in from the
provincial schools of nursing. I learned more about the course in Saskatoon from Miss
McCann, one of the district nurses with whom I spent a day. She had graduated from the
course just two years ago. She says that they take their first year in University.
During that time they have History of Nursing from Miss Ellis. This is the only subject
which she teaches them all the way through. Following their first year at University
they go into hospSal for three months, at the end of which time they are capped. Then
another university year and hospital for three months. When they enter at this time they
are put in with nurses who have had much more experience in the hospital add they find
this rather difficult as well as embarrassing at times. At the beginning of the third
year at tfaiversity they attend for one-half a year and then go back to the hospital for
a straight period, making a total hospital period of about 31 months. At the end of this
time they graduate from the school of nursing and from the university with a BSe.N. I
feel that the result of this is that the nurses are turned out with degrees and are not
prepared in either public health or in teaching and supervision. They have had enough of
university for a while and therefore, do not want to go back to study and I think it must
be harder for them to see the need for an advanced course. I felt this very definitely
from Miss McCann. She is an individual who likes to work on her own. She does not like
to take orders from anyone and I felt that she had a great deal to learn in public health '
but that she did not realize it herself, *~V#
Miss Smith seemed rather discouraged about the whole nursing problem in Sask.
There is apparently a great shortage of nurses and she does not see much hope for
obtaining anywhere like a full staff and that it will be a long time before they can
obtain trained people, (See notes and key form for the province),
I had a very interesting day with Miss McCann who is the nurse for the district , I
around Regina. She travels in a circle, about 100 to 125 miles south and then north-west:
to the Moose Jaw region boundary and north about 100 miles. I rather gather that she
and another nurse, Miss Brett, are often sent out on special Projects. They do very
little school work. Their area is so large. Miss McCann was going with Dr. Clancy, who
is a case in himself and who is a municipal doctor, for the immunization program.
Dr. Clancy apparently is one municipal doctor who keeps the immunization program up t»:dBg
date.
 -}02-
He gives a booster dose for diphtheria and scarlet fever every second year  He visits
££ st£ l:^ sernd tt» ,doing one-haif -* ^ra^s ^ JSoTSS
S?%h~ J^Sf ?    °Sa^ly *° ** ^astioned but he knows the people in the district
and they eertainly were bringing their children in for immunization. The nurse is nothing more than a secretary fpp him at this time and she spends two days a week for something like seven weeks doing this work. In the other districts, I believe, it is not
always the routine to have the nurse go with the doctor. Of course, in many of them
immunizations are not done. The district nurses are not certified to give immunization.
Miss McCann said that other projects include organizing for the T.B. survey; checking of
V.D. contacts and following up the cases discharged from mental hospitals. The nurses
seem to like to do this work. I felt that in this district and I suppose it is true in j
all other districts, the nurse is just touching the high spots. I suppose that it is
better that there be one than that there be none at all. They do a certain amount of
school work. They will visit a school, inspect all the- children, there are no medical
inspections. Make out a family folder and card for each child and then, while they are
in a community, visit every home, whether there are defects found or not. They may not
be able to do this in a school more than once in four years. It seems to me that here
is where something ought to be worked out with the teacher, the nurse going in as
consultant to them. She would easily be able to contact all schools each year or maybe
two times a year on this basis.
Jtert Sanatorium - On Saturday I had an opportunity to go to Fort Qu'Appelle and visit
the San. for a short period. Miss Pearston is the lady superintendent. There does not
seem to be any definitely organized staff education program. There is no medical social ,
marker or rehabilitation officer. The follow-up is done by correspondence. This department is in charge of a Miss Mclnnis who was at one time on the cure and has been eighteen
years in this work. She has devoted her whole life to the erradication of T.B. This
flavours of personality. Miss Pearston has about 22 nurses and 38 nursing assistants, I
believe. These are not tkained nurse aides, they are brought in and just given some on-
the-job training. They have a good program for affiliating students but do not have all
students from all nursing schools. All the staff are given B.C.G. They have an in teres
ting department called "Prevent" babies born of T.B. mothers are kept there and given
B.C.G. and are not discharged until they are nine months old or so. They are also given
other immunization*,
f"T,pP ^GION #1. SWIFT CURRENT. Sasktt
We went to this region and stayed there for three days, October 25, 26 and 27.
This is a most interesting area as it is their demonstration area for complete medical
care. There is no doubt about it, that the availability of facilities for treatment is
a very great asset to public health work.
Dr. Simpson Matthews is the director of this region,
senior nurse.
Miss H.I. McColl is the
I
In the region there are six laager school units and three or four hundred local;1
school boards. Each municipality is divided into six townships. There is a total
population of about 51,000.
On October 26th we took a very long trip around the region, covering 350 mimes.«
Starting at Swift Current, we passed through Gull lake, Maple Creek and had a side trip j
down to Cyprus park. We then went north to Fox Valley to the dental clinic and still
further north to Leader, a third of their district offices. From there we drove to    t
Swift Current, arriving somewhere around midnight. The trip was a most profitable one.
Our first stop was at Gull Lake, where we met the nurse, Miss Stolhandske, This is a
sub-offiee of the Maple Creek District. Nurse Stolhandske has her living quarters and
office in the Hotel Clarendon. She trained at Medicine Hat, and her experience previous li
to coming with the Health Region, about six months ago, was entirely hospital. She has I
 -  -103-
Lrents J^^TS*0^ * f^i abOUt fifteen attend- She complained a bit that the '
^^ J^^fS' ^^^tion. We felt that this, perhaps, should be encour-
■ Z^l-ll    8 a**  ^bi6S ** her Centre *° ^ weighed. Her quarters consisted of
!!?*™^4If 2? 2 h2ffitting roora and office, and a second room was her bedroom
with partitioned off as a kitchen.
u^ob1Gb11 k*e we Proceeded to Maple Creek where there is a very nice district
office which also consists of two rooms, an office and another roora where literature is
kept and child health conference is held. The nurse here is Miss Caza. She has her
living quarters elsewhere. Miss Caza says she has about sixty-eight schools. She has
three baby clinic centres in addition to Maple Creek. These centres are held once a
month. Her centre at Maple Creek is held one day one week and two days the next. She
may have as many as ninety come in for these sessions. Miss Caza has also only been with
the department about six radnths. Her previous experience had been hospital work. She
seems to be quite a capable girl, but one cannot help feeling that both would benefit
greatly from public health training. However, they do a remarkable job without it. From
Maple Creek, where we had lunch, we drove down to Cyprus Park. This took about an hour ai
and a quarter extra. It is like an oasis in a desert, with lots of evergreens and
deciduous trees and is a summer resort. Returning through Maple Creek, we drove on to
Fox Valley where the dental clinic was in operation. This dental clinic is mobile ana
is manned by two dentists and one dental assistant. It moves about from place to place
and sets up in the community either in the school or in sorae other l