"CONTENTdm"@en . "http://www.library.ubc.ca/archives/u_arch/creelman.pdf"@en . "History of Nursing in Pacific Canada"@en . "Creelman, Lyle, 1908-2007"@en . "2015-03-17"@en . "1948-1949"@en . "https://open.library.ubc.ca/collections/creelman/items/1.0214446/source.json"@en . "171 pages"@en . "application/pdf"@en . " DIARY\nHAMILTON, Ontario\n HAMILTON\nMarch 11. 19A8\nMeeting of medical sub-committee in Hamilton, tir, Mosley, Dr* Puffer,\nDr. Hitching and Dr. Baillie sat in on first part and then came out to discuss\nsurvey with Mrs. Haygarth. There was a great deal of resistance on her part*\nThis is a bad time: - (1) x-ray survey - on discussion find that the only extra\nwork for the nurses is the following up of cases and contacts found. (2) measles\nepidemic - apparently nurses have to visit every case, chiefly for purpose of\nfilling out epidemiological card* Eointed out that survey might help in this*\nFinally, Mrs. Haygarth suggested that she gather the nurses in on Saturday morning\nand I could speak to them.\nMarch 13. 1948\nCame to Hamilton so speak to nursing group of which the majority assembled\nin the Health Centre. Mrs. Haygarth's reception a bit better - some of the nurses\nhad been coming in for reading material - they nwere jittery about this\". Don't\nknow what explanation was given on Friday*\nMarch 15. 1948\nMonday - returned to start survey. Interview 11-12 noon with Mrs. Haygarth.\nVery difficult to keep her to the point. Will take a long time and many interviews\nto get the required information. She seems to take on too much of the administrative\ndetail herself - question amount delegated to her supervisors - especially in Health\nCentre.\nLunch with Dr. and Mrs. Kit ching.\n1.30 p.m. went with Miss Dean (F.H.N.) to Immunization Clinic at Central\nSchool. Two other nurses, Miss Hilbert (in charge) and Miss Nugent. Also student\nfrom St. Joseph's. Dr. Laura Martin came to give immunisation. Elaborate set-up\nprepared. Syringes and needles boiled and placed between two sterile towels*\nImmunisation vials soaking in alcohol. Table outside door where two nurses worked.\nOne nurse (Miss Hilbert) went to class rooms to collect children. Second nurse\nchecked names on list and notified Doctor when special tests such as protein or\nSchick. Third nurse cleaned arms, (wore mask for this!) Technique used -\n1. Wash with green soap (great abs. swabs)\n2. Wash with alcohol (great abs. swabs)\n3* Swab with iodine.\nWith all this elaborate preparation - mask, etc*, the child was not told to hold\nhis sleeve up and frequently it dropped down and the arm contaminated*\nThe student asked what she could do. Was told, \"Oh, you can help the doctor\".\nThis was not really necessary. Could much better have been employed to clean\narms and thus relieve an extra nurse. Student not given any explanation of\nimmunization program. No teachers or volunteers used. Definitely a waste of the\ntime of at least one nurse. Left at 3 and clinic not yet completed.\n -2-\nMarch 15. 19A8\n3.00 p.m. Returned to elinics at Health Centre.\nChest Clinic - Miss Moffatt, nurse in charge.\nDr. Holbrook, doctor in charge.\nOne other nurse taking histories.\nStudent taking names, weight, temperature, pulse. Student had\nlittle opportunity to see more and would be there again.\nTwo other doctors - from San?\nA large clinic as many were coming in from Provincial survey. Three beds\nobtained immediately from Sanitorium for three cases. Excellent relationships and\nco-operation there. (Dr. Holbrook recently retired as Ch& at Mountain Sanatorium\nand works part time in Health Department Chest Clinic).\nDid not get much on follow-up by nurses. Obtain this later.\nBaby Clinic\nNurses had interviewed all mothers (28). Volunteer had weighed.\nTwo nurses * Miss Smith, Mrs. Dingwall\nDr. Carr, Pediattician, arrived late.\nObserved Dr. Carr. Mother would sit down - he read nurse's notes and\nquestioned on feeding. Made suggestions re diet frequently* Initiated notes and\nmother left. About 1 minute] New babies were placed on table by nurse and examined\nvery, very briefly. Nurse was frequently lax here in not bringing mother into the\npicture as much as possible. Too much banter between nurse and Doctor in front of\nmothers. After all cases seen by Doctor, immunization was given. Bo masks here*\nWhy difference?\nMarch 16. 1948. (Tuesday)\n9.00 a.m. At Mcllwraith school with Miss Harley. This school is in rather a poor\ndistrict. Children all have rather low I.Q. Pediculosis cases quite numerous. A\ndifficult group to teach and therefore all the more need for demonstration and\nillustrative material. Met Mr. Lowden, principal.\nRoutine of school work seems to be:\n1. Test children for vision, weigh and measure.\n2. Test hearing.\n3. Referal of kindergarten and Grade I pupils not examined in summer\nto doctor*\n4* Doctor examines Grade 8 and if possible Grade 5.\n5. Referals from nurses' screening to doctor.\n6. All corrections, except dental, must be referred to doctor to mark\ncorrection on card.\nMiss Harley referred to what she was doing as the \"Thorough Class Room Inspection\"*\nTeachers do not weigh or measure or test eyes.\nNurse does not give class room talks*\nSeemed to be rather a lot of clinical work. Several lists, forms for immunization,\n -3-\nconsents, etc. No clinical assistance in this school for teachers.\nRe Sanitation - nurse seems to take little responsibility. Apparently the doctor\nand nurse make one inspection yearly. Remainder of the time, the nurse accepts\nany complaints.\nRe Communicable disease \u00E2\u0080\u00A2 Special class room checking for scarlet fever and\nother serious diseases.\n(See write up of school visit No. 1)\nLunch with Dr. and Mrs. Hitching.\n2.00 p.m. - Met Miss Fawcett who is on the staff of Health Dept. but is in\ncharge of V.D. and Pediatric clinics at hospital. Appointment arranged with\nher Monday, March 22 at 1.30 p.m.\n2.15 P.m. - Visited Baby Clinic at Health Centre. Same two nurses as yesterday*\nMrs. Dingwall not usually at this session but regular nurse ill. Not as large\nan attendance. Seemed considerable waste of time. Miss Smith could have been\ndoing records after preparing her part of the clinic.\nSat with Mrs. Dingwall during her interview with three mothers - two new babies*\nTook information for front of history form. Asked routine questions re formula,\nextra feedings, C.L.O. etc., and sleep. Re-appointment made. Asked one re\nvaccination and arranged to give to-day. Others not old enough for immunization*\nHo literature given or referred to. Nurses have only regularly printed literature.\nBox on desk contains forms only.\n(See write up of Clinic visit No.l)\n3.30 p.m. \u00E2\u0080\u00A2 Interview with Miss Helene Sneddon, Superintendent V.O.N. Very\ncharming and very friendly reception. No question but what nurses would do\njob analysis - would be very useful for them. Asked me to explain the survey\nto the group next Monday, 8.30 a.m.\nMet Miss Lawson, Assistant Superintendent and the Nutritionist. Arranged to\ninterview them also. Will arrange visits to V.O.N, after Easter in order to\ntry to complete Health Department before*\n Wednesday. March 17. 1948.\n9.00 a.m-\nInterview with Miss Wright, Supervisor at Health Centre. Miss Wright\nwas with the Board of Education before amalgamation. Her major experience has\nbeen in the school service and one has a feeling that this aspect is still her\nmajor interest. In discussing her duties it was hard -Mb pin her down to a definite\nsubject. In regard to the introduction of the new nurse - she feels that they\nneed a great deal of guidance. Wants to be with them most of the time in the\nschools 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 -\n\u00E2\u0096\u00A0ore a case of telling her what to do than guiding. Would not go with more senior\nnurse unless specifically asked and then it would be to solve some problem. Not\na real supervisory visit. No planned educational program. Is overwhelmed with\ndetail work, filing, etc., and cannot see the bigger issues over these. No time\nto go to committees and do what the health department wants her to do. Does not\ntalk the language of modern supervisor.\nAlthough monthly reports come from the main office giving statistics,\nrelative to to time spent in services, no attempt made to use this as guide. No\nidea of time percentages. Had figures of pre-kindergarten examinations but bad\nnot worked out percentage of total entering school*\nAlthough Miss Wright is available for nurses to discuss cases with her,\nfrom observation this seems to be done by going from desk to desk and telling\nnurse about new records which have come in. No planned individual or group\nconferences.\nWould think that in this centre nurses would be rather confused as\nMrs. Hagarth also goes over work with them.\nWhen asked about weaknesses in training, Miss Wright first mentioned\nrecords. When questioned specifically, this breaks down to local records* Feels\nthey should be better prepared to recognize all problems when they go into a home.\nAlso need more basic training in mental health.\nMiss Wright has a pleasing personality and is no doubt efficient in details\nbut modern methods and meaning of supervision do not seem to be comprehended. How\nimportant the supervisor is in a health program \u00E2\u0080\u00A2 it is probably in administration\nand supervision where we need to put more stress in preparation*\nWednesday. March 18. 1948. p.m. Back to Toronto\nThursday. March lfr 1948\n11.00 a.m.\nInterview with Miss Boyd at Queen Mary Centre. Mrs. Hogarth is really\ntrying. Took me out to the Centre - had the car washed because I would have been\nashamed to ride In it before m but did not go in with me. Had phoned Miss Boyd\nto be at the door so she would not have to take me down through the basementl\nMiss Boyd served in both world wars. Was in charge at Borden In the\nlast and later in charge on the \"Letitia\". Her experience has given her a breadth\nof interest and understanding which reflects in her supervisory program.. One has\na feeling that the nurses are allowed more initiative and are permitted to take\n -5-\nresponsibility just as soon as they are able. Her supervision is given according\nto need and there is more guidance in it than with the others* Is available at\nall times for the nurses and when conference is indicated brings them to her desk\nto sit and discuss. Has regular Saturday morning conferences. Has developed\nseveral administrative aides (carry over from the army, she says) which help, e.g*\nindex tafta* in record box. Miss Boyd also lays great stress on the immunization\nset-up and clings a little to the old custom*\nMiss Boyd was the only representative from Hamilton at the refresher\ncourse which was recently held at the School of Nursing. She got a great deal from\nthe lectures. She can see the larger issues and is not bogged down with detail*\nIn this supervisor we see the influence of a broader experience - not\nnecessarily a course In supervision - as a good background for supervision in\ncontrast to growing up with the agency and not having experience elsewhere* Personality no doubt figures to some extent also.\nThursday evening - With Mrs Hogarth attended the annual joint dinner meeting of\nthe Hamilton Community Chest and Council of Social Agencies. Held in Winston Hall\nwhich was used during the war to house some 300 war workers and has now been taken\nover by the I.W.C.A. Very attractive large lounge. Excellent dinner. Reports\nmimeographed into booklet and available for all. Synopsis of each brief and to the\npoint. Chancellor Gilmore of McMaster an excellent chairman. Panel discussion on\nhow money raised, very good. Over 200 at dinner. One had a feeling that the\ncitizens of Hamilton are keenly interested in their health and social agencies.\nThis was a large attendance, especially since this meeting was apparently the last\nof a long series of annual dinner meetings.\nFriday. March 20. 1948. - Went to office before going to school for observation.\nCold very bad and rain terrible so cancelled appointments and returned to Wentworth\nArms, (much nicer than Connaught) Worked all morning and returned to Toronto on\n2.15 train.\n HAMILTON\nMonday. March 22. 1948t\n8.30 a.m. Conference with V.O.N, nurse re survey*\n9.30 a.m.\nHamilton Branch Canadian Red Cross.\nMiss Buchbee, nurse-in-charge.\nConference with Miss Stevens. Director of Visiting Homemaker Service*\nHave 17 Homemakers. All go to Toronto for a two weeks course sometime during their\nfirst year. 8 of the 17 are on full time and the remainder on part time. Do not\nhave enough to fill calls.\nAccept 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\nall that is needed is perhaps one day a week - do some cooking, tidying up and shopping.\nEnough to keep the old people out of the Old Folks' Home*\nApparently the Family Welfare have a group of their own as well as V.O.N. Can also\nobtain Home Aides through Employment Service. According to last annual report of\nall the filled calls, 380 were made directly by client (sometimes told to do so by\nagency) and only 20 from other sources* This does not indicate very extensive use\nby agencies, Including Health Department.\nConference with Mrs. Cambridge. Nutritionist*\nA real live wire* Was with British Ministry of Food in England. (Replaced Jean\nRitchie, who, she said, was fired!) Last year was part time with the Health Dept*,\nbut that has been discontinued since January 1948. When asked why, she said the\nservices were not appreciated. Apparently there was some trouble with the Volunteer\nHome Economists who were available for counselling in Baby Clinics. Would be shoved\noff into a corner, - no effort made by nurse to refer cases, etc* This seems clearly\na case of the Supervisors and Director not appreciating the service and not guiding\nthe nurses in the use of a consultant service. There may be another side to the\nquestion but can't help but feel that the nursing department is most at fault.\nMrs. Cambridge also told me of the course of lectures she prepared and tried te\npresent to the nurses. One on budgeting - did'nt go over although she tried to make\nit practical. Said you realize you are not appreciated when a professional group\nyawn and look at their watches* So the next week she thought she would be technical*\nOne nurse came up afterwards and said \"I've been nursing for 26 years and I have not\nopened a text-book since I finished training. You don't need that information to\ntell the women in the north end about nutritionl\"\nAnother nurse said \"I hate nutritionl\"\nWhat is at the root of the public health nurses aversion to nutrition?\nMrs. Cambridge has many activities going now - are education for the\nco\u00C2\u00BBmity but instead of credit going to the Health Department it gDes to the\nBad Cross.\n 11.00 a.m.\nInterview with Mrs. Gallowayf President of the Hamilton Industrial Nurses I Association,\nat the American Can.\nCan get information through them re nurse in industry. As next meeting of the group\nis on April 5th*, invited nyself to it to tell them about the survey and get them\nto do job analysis. Very co-operative\n2.00 p.m.\nConference with Miss Fawcett at Special Treatment Clinic, O.P.D. of Hamilton General\nHospital. Miss Fawcett is on staff of Health Department* She is called the \"social\nservice\" nurse, at this clinic. The hospital staff of the treatment clinic, Miss\nFawcett interviews patients and is responsible for follow-up. The district public\nhealth nurse does not do any follow-up. There is an untrained man who sits in the\nmain office of the Health Dept. He is also apparently supposed to do \"follow-up\"\nbut this consists mainly of writing letters* (Later learned he is responsible for the\n'legal aspects')*\nMiss Fawcett says the number of delinquents is increasing,\nto check. Clinics are as follows:-\nShe has'nt sufficient time\nMon. 4 - 6.30\nM.\nG.C.\n& S.\nTues. 8.45-9*30\nM& F.\na\njf\nWed* A.M.\nChildren\nV.D.\n& Pediatrics\nThurs. 4 - 6.30\nM& F.\nG.C.\n& S.\nFri* 4 - 6.30\nM\nG.C.\nShe is at all these clinics and has the records to do in addition. Has a record clefrk\nas assistant. There is also a Junior League volunteer in each clinic who pulls the\nrecords as the patient reports* (Later Mrs. H. denied that any volunteer in V.D.clinic)\nMiss Fawcett refers to the social history. Saw several records. All that is written\nin this section is the date and circumstance of contact. Nothing approximating social\nwork done. However, Miss F. probably carries a lot in her head but this would never\nbe known to successor. Miss Fawcett says she has been there 10 years and had no\nsupervision of any kind. Would welcome it. Would also like to go away to take course\nand see what is done elsewhere. Told that this is not necessary* Miss Fawcett seems\nto be doing her best but would say she is somewhat limited. Would think she would\nappreciate some guidance. Both she and Miss Inrig, the nurse-in-charge of O.P.D* spoke\nvery highly of Dr. Leroux and appreciated the improvement he made*\nNumber of cases for February only 386. The greatest number was 506 - December 1946*\nThese figures seem low for an industrial city the size of Hamilton. Also several of\nthese are from district outside the city*\nLater was told that all cases are not reported to Health Office \u00E2\u0080\u00A2 are reported directly\nto provincial government. So attendance at clinic is not an indication of total\nnumbers.\nIn an interview later with Mrs. H. she said the nurses carry the delinquent V.D. cases\nwhen in families. Could not get this confirmed in actual practice*\n -8-\nTuesday. March 23. 1948.\n9.00 a.m.\nWent to George R. Allen school in Westdale to observe nurse and doctor.\nMiss Reid, who took her public health certificate at McGill and Dr. Glass, a local\ngeneral practitioner. Miss Reid very quiet, nice manner with children\u00C2\u00AB Dr0 Glas*\nyoung and interested in the work. Felt that too many referred needlessly to the\nDoctor (See School visit No. 2) Also a lot of doctors time wasted. Children not\nalways ready for the doctor. A very nice medical room opposite the main office -\nbut not one poster*\n1.30 p.m.\nSaw Mrs, Haygarth in her office while waiting for nurse to go visiting.\nOne remark made rather indicative of whole attitude. I asked her in which provincial\nsupervisor's territory was Hamilton. \"Miss Pentrpa*^ but she rarely comes. Miss\nNicolle come*more. She is the Educational Director. But we don't need help - there\nare plenty of places to go in Ontario where they have'nt trained workers\"*\nMrs. Haygarth complained agdinabout the nursing statistics being done in main office*\nAll these things possible of modification but she lacks the personality to bring them\nabout. Criticized the development of the V.O.N, into the health education field and\nwhen asked specifically does not know what Miss Sneddon means by their health education visits.\n2.00 p.m.\nOut with Miss Morrow, (See Home Visit No. 1). Miss Morrow was in the any\nand after returning took her public health at Toronto. Is in her late thirties or\nearly forties. Went first to Day Nursery. Really a wasted visit, Then on home\nvisits, all but one of which was for measles and in none of which was any teaching\ndone. Would consider it almost a totally wasted afternoon. It seems that for all\ncases of communicable disease the family doctor visits, an inspector from the Health\nDepartment visits and the nurse visits! What an utter waste of time especially if\nthe afternoon's visits are typical. Epidemiolpgical card is filled out. Just recently\nthe amount of information to be recorded has been reduced*\nWednesday. Mhreh 24. 1948.\nSpent morning at Health Centre with Mrs. Haygarth trying to complete\ninterview guide. Think this is not a good way to do this. At next place give separate\noutline for statistical information only. Remainder of outline to be completed as a\nresult of conference and observation and not gone over with Director. There is some\ndiscrepancy between what is said to be done and the actual practise observed. It is\nthe latter which is the most important for the survey. Also it seems to me that the\nmost valuable method of obtaining the information required is by getting out with\nthe nurses,\nMrs. Haygarth so easily put on the defensive.\n2.00 p.m.\nWent to Queen Mary Centre to go out with nurse. Miss Boyd took me to each\nnurse at her desk and introduced me. She had a nice word to say with each. How\ndifferent from the Health Centre!\n -9-\nWent home visiting with Miss MacKenzie who had the city car. A very\npleasant nurse - has not had public health - graduated from Toronto General and\nfollowing that took a P.G. in Pediatrics in Detroit. Was a supervisor in the\nPediatric Dept. for two years. Came home when her father died - 20 years ago -\nand has been with the Health Department ever since. Always wanted to take the\ncourse but never got away for it - always wanted to go other places but never did'.\nWould have benefited by course - can see how others have - and would be able to\ndo a much better job even without if there were a staff education program. Following\nthe visits I could not see where any health teaching had been done. The majority\nwere CD., and what is the sense of trying to talk isolation for measles to a mother\n(low I.Q, often) with three children in three rooms? Nurse did not try anyway.\nOur general health education should teach the method of avoiding complications but\nof what value is much else? Nearly all the mothers in those two visits had had the\nfamily doctor - even when the second child developed the disease,\n(See Home visit No. 2)\n5.15 p.m. Back to Toronto\n -10-\n\"HAmfON\nMonday. March 29. 1948\nOfficial call at R.N.A.O. office. Talked with Miss Fitzgerald and Miss Walker re study.\nLunch with Miss Walker,\nTuesday. March 30. 1948\nHamilton V.O.N. Conference in morning with Miss Lawson, Assistant to\nMiss Sneddon. Miss L. responsible for the introduction of the new nurse, student\nprogram and staff education program. Has a very well planned introductory program.\nHas a keen appreciation of modern educational principles - changes with the times \u00E2\u0080\u00A2\nstresses the teaching, techniques are secondary. Gives real supervisory visits and\nfollows these with a written report which is discussed with the nurse.\nIn discussing student program remark was made that students frequently say\nin relation to the V.O.N, experience - nD, this i so much more interesting than public\nhealth'\" Have only two days with the V.O.N. Have two weeks with the Health Dept. which\nis too long for observation.\nP.M. Home visiting with Miss Truesdale. Miss T. has been with the V.O.N, in Hamilton\nfor over twenty years. Has had public health. Her techniques were always good - her\nmanner friendly and interested (See report of Home Visit No. 3.)\nAttended V.O.N, staff Hard Times party. Very friendly spirit among the group. Have a\nstaff committee who are responsible for such things as well as for making suggestions\nregarding staff education program.\nWednesday. March 31. 1948.\nA M with Miss Sheppard of the V.O.N. (See report of Home Visit Nb.4).\nMiss Sheppaid has been unable, because of family ties, to take the public health course.\nESdUkTto have done so. is interested in her work and very ^^^\u00E2\u0080\u00A2^\ninto one home that had been in last week with Health Dept. nurse. (See Home Visit\nNo. 2, Visit 10). Overlapping seems obvious,\nP.M. H6me visiting with Miss Joliffe, Miss J. had her public J\u00C2\u00BB*tt *\u00C2\u00BB\u00C2\u00AB\u00C2\u00BB\u00E2\u0080\u00A2-\n1945-46. She is a bit \"off-handed\" and perhaps not quite as dire^ about ^r teaching\nas she kght be. Her technique might be questioned. For example, all the J*^\u00E2\u0084\u00A2-1*\nZrsel observed found a newspaper before putting bag down. Miss J. put it down on\nESfor co^A and got pape/afterwards. Also she used the same apron in a visit to a\npre^tSe \u00C2\u00A3oy (8Meksfthat she had worn when taking the temperature of a measles\ncase in the previous visit.\nAs we were late in starting and had to return to the office early only two\nalong. Also she ielt tha**\u00C2\u00BBJ2\u00C2\u00A3\u00C2\u00A3\u00C2\u00AB J^u, jJJ, M been i\u00C2\u00BB. Iajeeted blood inf\n\u00C2\u00A3\u00C2\u00A3 *ZZrltZltMdHET!JS\u00C2\u00BB. -*Shed, took temperature. Decreased for\u00C2\u00BBula,\n -11-\ntemperature of 2\u00C2\u00A3- year old orally. During course of conversation it was stated by\nthe mother - \"The man from the Health Dept. was in about quarantine and that he\nbawled me out because I had'nt reported the measles\" (Doctor had already reported\nthe older child). Mother was quite indignant about this*\nNext 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.\nNurse weighed baby and discussed general care. Mother asked questions. Mother sat\nrocking the basket in which the baby was lying. Nurse did not make any mention of\nthis although I am sure this Mother would have readily accepted and explanation of\nwhy this was not good for the baby.\nThursday. April 1. 1948\nA.M. with Miss Lelen at Moodie's Textile factory. Arrived shortly after\n10.00 a.m.\nThis is one of the seven industries which buys nursing service from the\nV.O.N. The nurse spends four hours a day, five days a week. This factory provides\nthe most ideal working conditions for the nurse of any of the others and is also the\nlargest served.\nThere ere 420 employees of which approximately 00% are female.\nThere is no part or full-time medical service. Two doctors may be called\nas consultants - it is mostly compensation cases which are referred.\nThere is no pre-employment physical. The nurse sees all new employees within\ntwo or three days after starting. There are standing orders covering first aid*\nDuring the morning the nurse saw about seven cases. Chiefly minor first add,\nmenstral .pain and follow-up from previous accident. In talking with all of them nurse\nbrought in general health habits. She seemed to knwo her cases very well.\nIt was noted that she did not use her records. There are individual records\nfor each case. In addition she completes a day sheet for the purpose of compiling her\nmonthly report. This sheet has the name of the employee seen, the reasons for seeing\nand treatment given and certain other checked information for statistics, I feel that\nwriting the name and reason for seeing etc., is needless. This should be written\ndirectly on the record. This nurse apparently just copies this information onto her\nrecord and is therefore, not using the record to the best advantage. (Discussed this\nlater with Miss Sneddon, who insisted this list was necessary and the records were always ,\nused when interviewing cases, except when a number of first aid cases at one time.)\nThese individual records had little or no social data. There was really very little\nfor a new nurse if there were a change.\nHer monthly routine reports to management were very good. Is concentrating\non the need for part time medical services and uses illustrations from actual cases.\nPrefers to follow up in home herself even though not in her own district.\nThis concludes the observations visits with the V.O.N. To prove there is * 1|\noverlapping following is a summary of home visits madd*with the V.O.N.s\n -12-\n1. Infant welfare - 3 months old (P.H.N, of H.D. had been in)\n2. \" \" - 8 wks. \" \" \u00C2\u00AB\u00E2\u0080\u00A2 \u00C2\u00AB n n n\n3. Prenatal\n4. Child Welfare - 3& year old girl had been ill six months previously when nurse\nvisiting for pre-natal case. Did not check if H.D. in*\n5. Medical - Insulin\n6. Surgical -, Breast abscess\n7. Infant welfare - 4 wks. old (Called previous week with P.H.N, of H.D.)\n8. General care - arthritis\n9. Infant welfare - 3 months old (P.H.N, of H.D. in re measles case)\n10. \" \" - 8 weeks old, but born prematurely. Did not check re H.D.\nSix infant and child welfare visits - none of these the regular (policy) 6 months\nvisit and only two under six weeks.\nIn no case do I recall was referral made to Health Department nurse, and certainly it\nshould be done for some of these cases.\nP.M. Observation in pre-natal clinic at Health Centre (Health Dept.)\n(See Clinic Visit No. 2)\nMiss Harley, the nurse in charge, assisted by one other public health nurse\nand two volunteers from the Women's Auxiliary. There was also a student from the\nGeneral Hospital. Would not let student weigh before volunteer came because - Mrs,\u00E2\u0080\u0094\u00E2\u0080\u0094\nvery fussy\". Only sign outside waiting romm was \"Chest Clinic\", A great deal of\nrushing on the part of the nurses to get the interviewing done before the doctor came.\nLack of privacy. Doors were not closed for interview with nurss. Iijroom where new\nadmittances were being interviewed door was open into office where chest clinic nurse\nand stenographer were working. Later the doctor interviewed his cases, which were not\nbeing examined, in the same room under same conditions but with one nurse and sometimes\ntwo, hovering over him. Very difficult for any patient to feel that she was the\ncentre of attention. Although there is a space on the pre-natal record for \"social\ndata\"' on none of the three cases newly admitted was any social data recorded. Instead\nHA this space an entry was made about whether or not the mother would make her own\narrangements about confinement and whether or not she needed a layette given to her.\nAnd one of the cases obviously had a problem - it was very noticeable that she (18 yrs.\nold and her second baby) was worried because her husband was out of work and did'nt\nseem to keep any work. This was just brushed aside with \"Don't worry!\" Cases who\nhad been at clinic previously for this pregnancy were interviewed by the second nurse\nwho had a much better approach. However, she did not touch on social prbblems either.\nHer questions were confined to the physical. One had a feeling also that the mothers\nmust have felt that the chief purpose of the interview was to get the record completed.\nWork slip for the district nurse was filled in during the questioning, although it\nwould have been much better to do it after the mother left. This nurse took the B.P.\neven on the newly admitted cases who were first seen by Miss Harley. And in these\nlatter cases there was some repetition in the interview. It apparently was not\nclearly defined what each should cover.\n -13-\nMiss Harley was heard frequently admonishing certain mothers not to wear\nround garters. One would think from her tone that it was an unpardonable sin!\nWhen the doctor came (late) there was a great rush to get the mothers who\nwere not being examined to see him. Even almost had them line up at the door. His\ninterviews in some cases, gave no more information than the nurses and it had been a\nlong wait for some of them.\nObserved the doctors examination of one woman. He called out his findings\nwhile Miss Harley recorded. Must have been rather upsetting to the woman to hear\n\"plus 1\", \"only fair\", \"considerable discharge\", etc., called out in relation to certain\nrecord items. One felt that the doctor would not use this approach with his private\npatients. His first contact with the woman to be examined was when she was on the\nayp^ning table. After the examination he would see her again. This interview was\nnot observed.\n\u00E2\u0080\u00A2 This clinic averages 12-17. They return every two weeks to the 34th week and\nthen every week. A specimen of urine is brought which is examined by the laboratory.\nIn relation to the size of the city, the total number of pre-natals seen at this\nclinic and the hospital clinic seems small*\nOne of the W.A. volunteers weighs the patients and charts the weight. She\nalso writes the name and weight in a book. (The nurse taking B.P. also writes name\nand 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\nsits right in the waiting room and there would be no secret about anyone who wanted\nh&p!\n -15-\nTuesday. April 6. 1948.\nAJk Observed post-vacation inspection at Armstrong School. Miss Tyson, the P.H.N.\nTook her P.H. in Toronto during 1945-46.\nSaw first inspection in Kindergarten class. 56 children. Nurse sitting.\nChildren in circle (very close together) and filed past nurse. Had them show hands,\nlooked in throat, and for each child took two tongue depressors and examined hair.\nDiscarded depressors. This seems rather extravagant as the technique consisted of -\n(a) proximity of children in line\n(b) the fact that clothes in clothes hangers are very close and frequently one on\ntop of the other.\n(c) technique used by doctors*\nAsked Miss T. if this was the technique as set down in policy for Hamilton.\nSaid she had taken her field work in Kirkland Lake, (Miss Pinchbeck there then) and\nshe thought it good. When she came to Hamilton they more or less left her on her own.\nJudge by this and other observations that -\n(a) Miss Wright does not give as close supervision of the new nurse and she would\nimply\n(b) there is not policy manual with techniques to be observed.\nNext class inspected was Grade 8* Each row lined up and same procedure gone\nthrough. Although nurse stood by the window, children-did not approach so that best\nadvantage was taken of light*\nP.M. Home visiting with Miss Tyson, (See report Home Visit No.5). A very alert nurse -\nshe likes her work and is very conscientious. Tries to keep it right up-to-date. Says\nshe makes about 40 birth registration visits per month* Says policy is to make a\nvisit then, at six months and a discharge visit at a year* Said she got all her\nmeasles cases visited - thought it rather foolish - just a case of dashing in, filling\nout card and dashing out again, \"But then, my opinion is never asked.\" Asked her\nabout unions - said did not have to belong and that she had never been approached*\nShe thought that in the Health Dept. only some of the older nurses who belonged.\nAsked about needs ln training, suggested that both psychology and nurtrition should be\ncompulsory and not electives. Feels a need for good staff education program. Tries\nto make the work interesting fof the student.\nIn the evening at Miss Sneddon's for bridge. Miss Sharps, Miss Allison,\nMiss Haverson, Miss Young, Educational Supervisor at Hamilton General, Miss Blackwood,\nPediatrics Supervisor at Hamilton General and Miss McLean. Miss Young is going to\nKitchener as Director of Nursing.\nWednesday. April 7. 1948.\nA.M. With Miss Lawson at V.O.N, discussing methods of supervision of nurse.\nP.M. Conference with Miss Nash.\n -16-\nFriday. April 9. 1948\nInterview with Dr. Albert Rose, Research Director, Community Chest of\nGreater Toronto. Had been informed that Community Chest had made a job analysis\nof agencies, including V.O.N. This analysis was done for the purposes of salary\nsetting, as have most of the analyses on which information is obtainable. Questions\nasked re age, qualifications etc., and asked to write a description of their job.\nWere also asked to estimate time spent on the various phases of their activities.\nThe examination of these job descriptions is made by reading them over and noting\nfrequency with which certain items occur. Actually no information is obtained which\ncould not be compiles by two or three people on the executive or supervisory level.\nThe time estimation was not used and probably useless. If time is needed have to do\na separate study. This interview more or less confirmed my own feelings in respect\nto job analysis.\nMonday. April 12. 1948 - Hamilton\nSpent the day - U a.m. to 3.30 p.m. with Miss Fenton at Mountain Sanatorium.\nShe is the senior of two public health nurses on the medical services staff. The\ninstitution has over 700 patients. 100 graduate nurses. 40 nursing assistant*# The\ntwo public health nurses do the only social work. Have no clerical assistance. They\nadmit all new patients. Try to give them a friendly introduction. All new patients\nadmitted to one ward. Miss Watson tries to follow up the teaching while they are\nstill on this ward. Was told relationships with Toronto Health Department are much\nbetter than with Hamilton. Miss Larkin, P.H.N., T.B. Supervisor for Toronto spends\nabout five days every two months at the San. interviewing Toronto patients, A few\nyears ago a P.H.N, from Hamilton Health Department came up but she reported back that\nthere was nothing for the P.H.N, to do and so the relationship between the district\nand the San. was not established. Miss Fenton says Mrs. Granat, social worker of the\nSamaritan Club gets a more complete report than the N.D, on discharged cases and that\nshe follows up in the home. Arranged appointment to see Mrs. Granat,\nSat in on Miss Fenton's lecture to D.V.A. post-grads. See material on file*\nSee also copies of two other lectures \"The Public Health Nurse in the Tuberculosis\nHospital\" and \" The Patient as an Individual Public Health Problem\", Both Miss Fenton's*\nIn the latter raises the question of need for sterilisation of dishes for discharged\npatients.\nWednesday. April 14. 1948\nA.M. \u00C2\u00AB\u00E2\u0080\u00A2 Appointment with Miss Maloney, service nurse for St. Elizabeth's, Order has\nfour nurses in Hamilton, one of whom has P.H. training. Cover approximately same\narea as V.0.1. Do not send any reports to M.O.H. Have a medical advisory board -\nany three doctors. M.O.H. not included. Feels there is little overlapping with\nthe Health Department because as a rule, she says, the Health Department nurse does\nnot get in before six weeks. St. Elizabeth's carry the baby for six weeks. If not\nunder the care of family doctor, then refer mother to C.H.C. Many doctors have their\nown baby clinics. If mother returns from hospital and is not going to be under Doctor,\nSt. Elizabeth'd refers her immediately to C.H.C. and they will not go in.\nWould like to have a staff of five nurses and prefer the P.H. trained.\nHaving a p.g. student from Toronto during May. In September w/ill start taking\nintermediate students from St. Joseph's Hospital for nine days observation*\nSee file for statistics from St. Elizabeth's.\n -17-\nApril 14. 1948.\nEJL. Interview with Mrs. Granat, Executive Secretary of Samaratin Club. Social\nwork training at U.B.C., 1939. Worked with C.A.S. Vancouver*\nMrs. Granat visits the San. every Tuesday morning where she interviews every\nnewly admitted Hamilton patient and does follow-up on other Hamilton cases as indicated.\nOf perhaps four newly admitted for the week, she may carry two as cases. For the\nothers she will make out a card \"No case made\" to have for future reference.\nMrs. G. does all the T.B. social work for Hamilton cases. Contact with the\nHealth Department is practically all done over the phone and mostly with Mrs. Haygarth\nrather than with the nurse who is actually carrying the case. The P.H.N, may phone in\nabout a case but from what I can gather, it would mostly be about material relief*\nThere seems to be a lack of understanding of what the T.B. case worker has to offer,\nor else the feeling is that the case worker's field is quite apart and there is a\nlack of working together on the case. Osier - \"Tuberculosis is a social disease,\nwith a medical aspect\". This is probably true, but isn't the nurse letting too much\ngo here by not maintaining closer contact with the social worker*\nnecessary,\nMrs. G. Gets full report on discharged cases and will do follow-up when\nDiscussed relationship between M.S.W, and P.H.N, Mrs, Granat thinks that\nshould be M.S.W's at Sa, Says the P.H.N's there are doing mostly social work,\n(Miss Deeth on Tuesday said that she had made a very thorough job analysis of the\nduties of her staff at the Toronto General Hospital, Only two items could be said to\nbe health education. All the remaining duties were those of a social service worker\nand mostly called for case work skill)\nMrs. G. feels the P.H.N, should have courses in fcpychology, sociology and\nenough on case work to give her an understanding of what case work is and to enable\nher to recognize when the problem should be referred*\nSamaratin Club is the Family Service for T.B. cases, 140 picked women*\nAll have to do some volunteer work. Raise large amounts of money and in addition\nhave grant from Community Chest*\n -18-\nQgQRD COUNTY AND INGSRSOLL HE^ra~UNIT\nFriday. April 16. 1948.\nDrove to Woodstock with Dr. Baillie. Met Miss Grieve and Dr. Powers. As\nthe nurses were all to be in the Unit on Saturday morning, I stayed over to speak to\nthem. Commercial Hotel*\nSaturday. April 17. 1948.\nOxford Unit has six nurses in addition to the Supervisor - Miss Grieve,\nMiss Mackay, Seniors' nurse} Miss McNaughtin, Miss R. Grieve, Miss Walton, Miss Moore,\nMiss Foster, There are also three students with them the month of April and there\nwill be another three next month. This group are from the University of Iondon.\nSpoke to the whole group about the survey and distributed the forms. They all seemed\ninterested and willing to take part. Had a little discussion on the public health\nnursing course. At London, both psychology and nutrition are compulsory. Social case\nwork is elective. If they do not elect it, they get nothing on social work except\nas it is brought into the public health nursing lectures. Miss Mackay who took her\npublic health at McGill and had lectures from a member of the social work staff,\npointed out how valuable they were to her and that in public health nursing we need\nso mai^ of the techniques used by the social worker. Caught 12.52 to Toronto,\nMonday. April 19. 1948.\nCame to Woodstock last night. Met Dr. Powers and Miss Buchanan (student)\nat Health Unit at 8.15. A morning of immunization at five rural schools in Blenheim\nTownship. Met Miss Foster at the first school.\nX -2-m ScX^mX (f*\u00C2\u00BBA -ru*3 J\n1. Ridewood School. Mrs. Cassidy, Teacher. 34 pupils* There one-half hour - Dr.\nGrieve. 8 S.F., 2 vacc*\n2* Muma School - Mrs. Smith - 10 pupils. Doctor gave 3 S.F., - 10 minutes.\n3. No.9, Miss Culman. 16 pupils. Doctor gave 7 vacc. - 10 minutes\n4, Wolverton - Mrs. Soarks. - 15 pupils. Doctor gave 1 S.F., 3 Vacc.\nVacc*\n5, Springhill - Miss Hill - 18 pupils. Doctor gave IL S.F., 1\nThe scarlet fever were all third doses and the vaccinations mostly\nre-vaccination.\nThe immunization equipment is carried in a large tin box U^hing ***>\u00E2\u0080\u00A2*\nsterile towel is put over the topy tray and sterile syringes a^ needles F*\u00C2\u00AB* \u00C2\u00A3\u00C2\u00BB\"\u00E2\u0080\u00A2\nA sterile towel is put over them and they are ready for a second school. In spite of\nve^ cSef^ tecSi^e on the part of allconcerned in setting up the tray and ^eansing\nlh7\u00C2\u00A3lZ, neither doctor nor nurses washed their hands once during the entire morning.\nThese five schools were quite a typical cross section I ^^e- *h* \"f00\nschool board is gradually getting improvements made. Water, ^c^Pb?^J base\"\n\u00E2\u0084\u00A2+ -i+fc furnace already put in Wolverton. Janitor problem difficult in all.\nS^SlfSr.l^tSStar. terrible. Wash basin in corner mt*. looks as\nthough it had never been rinsed. Entrance not swept out.\nMiss Foster has 30 schools - one, 3 roonsj - four, 2 rooms? - twenty-five,\none roo\u00C2\u00AB. Wsits \u00C2\u00ABch aboj* once a \u00C2\u00BBnth. Her headquarters are in.Dru*o.\nt^SJSX S\u00C2\u00A3E?^so^af JodiS in bloom in one 7eard. Saw two\n\u00E2\u0080\u0094 -\u00E2\u0080\u0094\u00E2\u0096\u00A0iftMifiiga\u00E2\u0080\u0094*\n -19-\ngroundhogs. Dr. rowers pointed out the marshes made famous for the &\u00E2\u0080\u0094wc\nAt lunch Miss Grieve told me about the little Anglican Church near guelph\nwhere the man Florence Nightingale loved, preached. The family would not permit her to\nmarry him and so he came to Canada. Preached at this little church and while he was\nthere Florence Nightingale sent a communion set. This is now in a special place in the\nchurch. The man died of T.B.\nP.M.\nDrove with Dr. Powers to Child Health Conference at Brownsville (about six\nmiles from Tillsonburg). This conference held in old library building. A new community\nhall is nearly completed and very soon they will have space in it for the C.H.C. There\nquarters are very cramped. Miss Grieve is the nurse in charge and a student was with\nher. The student assisted with the immunizations and did not listen to the conferencing.\nPerhaps that is because I was there. A volunteer of the Women's Institute weighed the\nbabies and pre-school childrem. The surprising thing was that the doctor seemed to be\npresent to do immunizations only. He only looked at one child and then only to examine\nears with auroscope because especially asked by the nurse. His work record for the\nafternoon was the giving of scarlet fever toxin or combined or booster doses to 9\ninfants or pre-school children; third dose of scarlet fever to 10 school children who\nhad missed the last visit at the school and 11 vaccinations to infants or pre-school.\nHis day's work included the addition of the few immunizations done at the schools in\nthe morning. With the nurse in the hospital now doing intravenous, giving streptomycin, .\netc,, why in the world can't she do a simple intradermal test for scarlet fever and a\nlittle scratch for vaccination/ (-^* CAumZLx. u**zi *>w 3J\nIf in this case, the immunization had been combined with physical examination\nor some other work for the doctor it would not seem to have been such a waste of time*\nIn addition, if a student is not with the nurse it is customary for two nurses to go\nwith the immunization to the schools and to the C.H.C.\nDr. Powers goes to Brownsville C.H.C. only about four times a year for\nimmunization. The remaining conferences are held by Miss Grieve alone. She was very\nnice with the mothers. She mentioned afterwards how difficult it was to conference\nwhen it was an immunization clinic, Her space was not private enough and the chief\npurpose the mothers had in coming was to get the immunizations. In her conferences the\nquestions asked were the usual about diet. Only once was toilet training mentioned and\nthat because the mother siad the boy had had a hydrocele drained. Nothing about sleep,\nplay, etc. Any records seen have ofily remarks in relation to diet and the obvious\nthings a mother would tell.\nBabies not undressed to be weighed. Think this not good. One mother mentioned\nshe was still strapping the baby's navel. Doing it herself. Should have been inspected.\nOnly pamphlets displayed were the usual Metropolital Life, etc. No*reference made to\nthem. One woman (nurse) took one.\nNo hand washing facilities.\nAttendance was 15 mothers with 8 infants and 14 pre-schools. Miss Grieve says\nattendance at non-immunization C.H.C. averages from 5 to 10 (nearer 5)\nArlington Hotel, Tillsonburg.\n -20-\nTuesday. April 201 1948\nMet Miss Moore, nurse for Tillsonburg and South Norwich at 9.00 a.m. Went\nto her office until 10 a.m. Office consists of a small ante-room, a small office room\nand a store room large enough to set up for immunization for C.H.C.\nPopulation\nTillsonburg 4064\nTownship 2000\nSchools - Tillsonburg, Public - 800 - 900\nSeparate - 150-200\nHigh School - 200-300\nKindergarten - 80-90\nTownship, Consolidated 7 room school in Otterville\n- 4 one room schools. Range 25*48 pupils.\nTime divided:\nMonday and Thursday a.i\n9-11, Public School\none hour to kindergarten\nFriday a.m. Separate School\nWednesday, all day - Township Schools.\nC.H.C. - two a month in Tillsonburg, one of which is immunization clinic. Average\nattendance - 30 for immunization - 8 or 9 on other day.\n- one a month at Otterville - average attendance 6,\n- Mothers \"go to their own doctors\" - Dr. Powers only examines those who do not.\n(Public Health Nursing service have to offer more if we are to get mothers to come to\nC.H.C. Won't come just to tell nurse what the baby eats!)\nFor home visits to C.W., Miss Moore looks at birth announcements in the local paper.\nCan make visit earlier than if wait for birth registration to come from Toronto. Tries\nto visit within the first two weeks. At this visit gets the history. Only does\ndemonstration bath if arranged for before delivery - otherwise does not get in on visit\nin time for this. (Could visit local hospital and make contact there for this. Over\n500 babies born there last year - at least one-third would be from Miss Moore's\ndistrict.) She has only given two demonstration baths since she came last Fall. No\nhome conferences - although sometimes obstetric patients have to be in the corridor at\nthe hospital.\nPre-natal - only five being carried at the present time. None of these referred by\ndoctors - were picked up at C.H.C. Visits once a month to several months and then\nevery two weeks.\nTuberculosis - Has only three cases now. One of these is active and won't go to San.\nThe other two are arrested cases. Visits all these once a month. Has three contacts\nto visit to see if had x-ray.\nVenereal disease - has only had 4 contacts to look up. None found.\nMental Hygiene - has not referred any since she came.\nSecondary school here is very crowded and there is just no spaae for the\nnurse. She is in her office on Tuesday mornings and if needed they can call her.\n -21-\nOtherwise no work done there. Miss Moore realizes the defect in this but feels she can't\ndo much about it. She is very conscientious but needs a lot of guidance and assistance\nin developing new projects. Seems afraid to put herself forward. Is not sure but what\nshe would like to go back to institutional work - can see results faster. Here again,\nwe need to give our public health nurses more to work with - more to do for the patient, e.\ne.g in infant welfare visits why not weigh baby and take temperature if for nothing more\nthan making an opportunity for the mother to bring up problems by reason of making the\nvisit longer.\n10.15 a.m, made two home visits for measles (In same apartment house). One was about\na ten year old girl who had just broken out in rash. No temperature takem. Advised\nfluids, keeping dishes separate and boiling since there was a 7 year old boy. Other\ncase across the hall also a ten year old girl who had just broken out and who seemd quite\nsick. No temperature taken. Urged mother to get doctor and in the afternoon checked to\n! see if this had been done. Suggested mouth wash.\ni Visited nursing home - private - where most of cases are pensioners. True to form of the\nway most co\u00C2\u00ABranities seem to be neglecting their old people. 12 patients and four empty\nbeds - both male and female. Very crowded. Mrs. Laymann probably gives^adequate\nI physical care but that is all. Just nothing for the old people to do but lie or sit.\n\ Although it was after 11 a.m. only one was up in a chair*\nIn the afternoon Miss Moore called at a school. Teacher had reported two\n: children absent and thought chicken pox. Called at school to find out where a family\nlived to whom she wanted to make an infant welfare visit. Did not inspect children\nfor chicken pox - nor did she when she returned to let teacher know that they did.\ninstil, visit to cases - One family. Large farm house. Little girl and boy. Both broken\nI out on Sunday. Very few spots. Boy's healed but advised to keep out all week.\nf s,\u00E2\u0080\u009E-?s--n2: x sir.srss: ssrs m;\u00E2\u0080\u009Efs iss rs\u00C2\u00BB>\n| BLrxsttmttrmZVtfi s^sssrsr.\u00E2\u0080\u0094- .\n1 Nurse had left a card and asked her to call if wanted anything.\n2. If nurse had wieghed baby - undressed and temperature.\n\u00C2\u00A3 !2& SftSiSS/Ui JSTXZZtttZ ]af- 10 graduate nurses,\n1 assistant nur\u00C2\u00AB, 2 practical nurse category and one ward aide.\nMiss Carson did not appear very professional - no cap, brown shoes and\nstockings but Siss Moore said she ran the hospital last year without deficit.\nI Evening - with Miss Mere to \"-\"\"\u00E2\u0080\u00A2^\"^J\"^\"^^. ^S-\ni Norway. yd^d^^^f9^\nJim* 3. 1948\nP^w, to going ^^^l^l^Tto^T^^^^^\n^^^f^U^C^lL^aUrEesearch. S.nt complete forms to\n -21a-\nWednesday. April 21. 1948\nWith Miss Moore to two schools. Miss Moore checked vaccinations for about a\ndozen children and weighed all childrem. She has weighed the class three times since\nSeptember. No reference made to gain. Says teacher records, (I did this which was\nprobably why she did not ask her.) Then went on to Otterville School. Six roomed\nconsolidated. Miss Moore checked some vaccinations*\nBack to Hamilton by bus and 5.15 train to Toronto*\nApril 22 and 23. 1948 - Attended sessions of R.N.A.O. Annual meeting. Miss Fidler,\nPresident. Spoke about survey at the Public health section meeting, Friday morning.\nApril 26. 27. 1948. - Attended sessions of Puboic Health Officer's Association in\nHamilton. Speakers of note: Dr. Vaughan, Dean of School of Pubftie Health, Ann Arbour -\nurged M.H.O's to get the support of the public through key lay people - suggested as a\nmeans of recruitment that a scheme be developed to qualify men for both clinical medicine\nand public health.\nChancellor Gilmour of McMaster in his speech entitled - \"The Little More and How Much It\nIs\"., urged the addition of the larger interest to our ordinary work.\nProfessor Bladin's topic - \"Working Relationships\" had much which can be applied to our\nwork, e.g., rest-break, interest in staff nurses' work, etc.\nApril 27. 1948 - Came to Woodstock last night. Commercial had cancelled reservations ss\nhad to stay at Mrs. Amos' Tourist Home.\nOut in district with Miss Walton. Miss W. had a year and a half in the army,\na summer with the V.O.N., Public Health course at London, Ont., and came to this Unit\nlast August. She has the townships of East Nissouri and West Zorra, inlcuding the towsa\nof Embro (office there) and Thamesford. Total population, 4\u00C2\u00BB80O. She has 23 schools\nand two High Schools.\nAs with all the nurses, her case load is chefly schools, pre-school and infantse\"\nShe has no T.B. eases, only one V.D., who is under treatment add three pre-natal. In\nexplanation of the small pre-natal case load, she says that the doctors do not appreciate\nthe service the nurse can give and moreover, in the country, many of the pre-natals do\nnot want neighbors to know of their pregnancy and do not want the nurse to call. Is the\nanswer here not that we must demonstrate that we have something of value to give in our\n[visits? Same applies'in C.H.C. which are poorly attended.\n1* Visit to #7 School. Teavher, Mr. Bender - no training. Uries to wei^i 30 pupils\neach month. Teacher does not help. Got five beginners ready for doctors examination\nj next month.\n\u00C2\u00A7L Harrington School - Miss Smith - 36 pupils. Weighed and measured all class.\nI Measures 2x year. Told children of gain or loss (See School Visit No. 4).\nIn afternoon made five home visi/tsf (See Home Visit No. 6)\nDrove back to Woodstock via Thamesford. Very pretty community and surrounding eountry.\nMiss Walton has a very nice approach to teachers, children and mothers. Inspires confidence. Seems to have good knowledge. Interested in her work.\nIn relation to schools - a trained teacher of Manual Training and Agriculture,\nspends one-half day in each school; a music teacher spends one hour a week (Mostly theory\nand not very practical) and a projectionist, with films once a month. A nutritionist\n -21b-\nvisits and helps out with hot lunch programs in the winter.\nThursday. April 28. 1948 - To Ingersoll, Ont. with Miss Ruth Grieve.\nAt Denham School, 2 rooms (24x18). Miss Latimer, principal. Miss Grieve inspected two m\nnew Grade L pupils and tested eyes. Good individual teaching with these. Tested hearing\nof two Grade I children referred by teacher and confarnnced with teacher about them and\nothers. Thought she missed the point in relation to one of these little boys. The\nteacher complained of him being listless, day-dreaming and never getting his work done.\nWas keeping him (and other little ones) in at recess to finish arithmetic. His hearing\nseemed O.K. Said she would have the doctor see him. When I mentioned Mental Hygiene\nClinic later she seemed rather surprised that he should be considered - \"Would want to\nobserve his more first before alarming mother\". Did not mention anythihg about visiting\nin the home to discuss his day-dreaming with mother. Miss G. did not say anything to \u00C2\u00B1k\nteacher about keeping him in.\nWhile in the senior room a health lesson was going on with Grade 6. Teacher\nwas reading questions from what was presumably a prescribed test and children were\nwriting the answers. Soke of the questions were -\nName the four parts of the heart? To what mechanical apparatus can the heart\nbe compared?\nWhat is haemophilia? Name the main arteries?\nAll factual! What about interesting projects to teach how to live healthy?\nMade two home visists - follow-up of hearing defect and youngster who had been hit over\nthe ear - (See School Visit No. 5) and Home Visit No. 7)\nLunch in Ingersoll with Miss M. Grieve and Miss Smythe (student)\nAt C.H.C. in afternoon with Miss MacNaughton, Miss Pickering, student there alsc\nMrs. McFarlane, volunteer* C.H.C. held in Y. rooms. No other activity there them.\nC.H.C. held weekly and one week a month the doctor comes for immunization. At these times\nabout 30 attend. At regular clinic 8 to 10. Only four to-day. Miss MacNaughton very\nupset about the small attendance. At immunization clinic, four rooms are used. These\nare available for all clinics if wanted but only one is used. This means lack of\nprivacy. \"Our Baby\" booklet only educational material out and this not referred to at\nall. Two health posters in room (See clinic visit no. 4).\nMiss M. Grieve and I drove from Ingersoll to St. Thomas and had dinner with\nMiss Horton and Miss Jones. Most enjoyable. Miss Jones returning home in July. Has\npart of city as her district. Mostly school wo$k. Says very little C.N. work done.\nReason: most go to own doctors and we have nothing special to give in C.H.C's, Drove\nto Port Stanley after. Terrific sanitation problem there.\nFriday. April 30. 1948 - Wrote reports, obtained statistics from office, conference with\nMiss Grieve. Assisted Miss. G. in evening with pre-natal visit script for local radio\nprogram.\nSaturday. May 1. 1948 - Visited market before 9 a.m. Maple syrup - $1.10 per quart\nplus 15^ for jar.\nConference with nurses who had completed job description and school information\nquestionnaire,\n -22-\nMiss Nicolle for her comments*\nC a^,. o-c^t. v\u00C2\u00BB p it ]\nmeeting in Vancouver was very successful and the weather man certainly\ndid his part to make the stay there a very enjoyable one for, I think, most of the\neastern visitors. Sessions were very good and there were many very interesting papers\ngiven. The difficulty was that it was Impossible to get into all the Section meetings\nand hear the various speakers*\nReturned from Vancouver, Saturday, May 29th, having left on May 25th. Phoned\nMiss Keefer and made arrangements to do some observation with the Hospital Health\nService of the Toronto Health Department*\nHospital Health Servicesn Toronto Health Department.\nBet with Miss Keefer and Miss Carrol on Tuesday to discuss visits to hospital\nhealth sefvlce. Miss Carroll is the supervisor of this service and there are some\ntwenty public health nurses in various hospitals ln Toronto* The Toronto General Hpl*\nhas their own set-up. In the hospitals where tare is this service there are no social\nworkers. They stated that Hospital Health Service nurses do the necessary social work.\nIn the Toronto General Hospital however, there is a social service department under\nMiss Deith. Nevertheless, all of her staff, with the exception of one, are public\nhealth nurses, (a written description of service is in folder.) Miss Keefer and Miss\nCarroll were most anxious that I get a good picture as they feel very definitely that\nit is a most Important link with the District. This point is very much emphasized.\nThey feel that it is most valuable to have a member of their own staff in the hospital,\notherwise, the link would not be so satisfactory. Nurses who are assigned to this\nservice are specially picked and all have had several years experience on the district*\nOn Wednesday morning I reported to the Health Service of the Toronto Western\nHospital. Miss Bird is in charge and there are four other nurses. Miss Rows, Miss\nNettleton, Miss Webb and Miss Smith. There are definite clinics at which these nurses\nare present. These clinics are, V.D., both male and female, neurology, heart and eye\nclincis. Diabetic and chest clinics. The other clinics are not necessarily served by\nthe nurses, butt their services may be requested when necessary. Pre-natal clinic also\nis one at which the nurse Is always present, Miss Webb seems to be responsible for this.\nThe clerical staff Is rather small. They have one for one full day and two half days\nper week, and there is one clerk working full time on the V.D. clinic but she is a\nhospital employee* As previously explained, the nurses act as a link between the\nhospital and the district, sending information out to the nurses on new admissions and\non any special cases. They also attempt to do what they refer to as \"social work\".\nRequests may come from the wards for the nurses to visit special patients. It is also\nroutine for Miss Webb to visit all maternit cases who have been through the pre-natal\nclinic.\nPerhaps the best way to record the observations made would be to write down\nthe conferences as observed with the nurses during the two days at Toronto Western Hpl.\nFollowing the initial interview with Miss Bird, I was introduced to the\nvarious workers. I then spent a little time with Miss Smith who was \"on the desk\".\nApparently when the nurse is serving at the desk she is available for any calls which\nmight come in. If they relate to any of the special clinics, as mentioned above, and\nfor which one of the five is definitely responsible, she refers the problem to that\nnurse. If they do not relate to any of these special clinics she tries to handle tha\nproblem herself. I did not observe with Miss Smith very long because everything segmed\nto be very confused. There was a Neurological Clinic on at the time. Miss Smith/called\nby a doctor to take a woman who was an epileptic out and arrange for some place for her\nto have a rest before returning home. I accompanied Miss Smith to the office. The\nwoman was extremely upset and was trembling, however, the doctor thought she was ready\nto go out to another room. It was decided that she would rest and the ambulance would\nbe called. As she left the door she fell into an epileptic fit.\nAnother case she was\n -23-\nattempting to do something for was one that was reportedly Addison's disease and had\nbean referred in froa the Salvation Any. She was trying to get more information from\nthe District. A third case was a conference just standing in the waiting room of the\nOut-patients department. A woman was trying to get some assistance in relation to a\nclinic she should go to. She discussed her whole family history right there. I did\nnot stay with Miss Smith very long, but it does seem to me that being on the desk, the\nnurse serves as an errand boy and does everything which nobody else seems to be\nresponsible for.\nI then went with Miss Nettleton to the Eye Clinic for which she is responsibl*\nthree mornings a week. By responsible, I do not mean that she is responsible for the\nadministration, it is her duty to be there to check the cases which need her. We\nstood there for some time but there did not seem to be anyone who was going to require\nher services. I believe that her work would be chiefly seeing that glasses could be\nobtained and arranging for the finances, etc.\nThen went with Miss Webb to visit patients in the maternity ward. We\nentered the ward without first contacting the ward nurse or referring to any charts.\nThe patients visited were in two eight bed wards,\n1, A mother with a day old baby. The mother was giving the baby its bottle at the\ntime. The nurse's first remark - \"You only got in once to see us at the clinic\", and\nthen - \"Are you not going to nurse your baby?\" She followed this by a talk, which\nwas almost scolding, on the value of breast feeding over bottle feeding. By the look\non the mother's face she somewhat resented all this. The nurse then told her to be\nsure to come back for her check-up at the end of six weeks. Never once did she refer\nto the nice baby which the mother had in her arms, I believe this case was also a\nV.D. but no mention was made of this*\n2* A mother who was nearly ready to go home. She had a rather low I.Q, and was of\nforeign birth. The nurse reprimanded her about coming to the clinic only once, and\ntold her to remember about the nost-natal examination,\n3* A mother with a five-day old baby* She was feeding the bab$ at the time. Told\nthe mother to remember about the post-natal examination and said - \"Aren't you going\nto nurse your baby\".\n4* A young mother whose baby was not with her. Asked her how she was feeling and\nsaid that she was up ln the case room with her. The mother had apparently called for\nMiss Webb. Told her to remember about her post-natal and said that the ward nurse\nwould be giving her a card with the date. The mother asked re the hospital bill,\nabout which she was somewhat concerned. The nurse said that the Finance Officer would\ncome to see her*\n5* Mother with a one-day old baby. Launched right in on a discussion about breast\nfeeding* This mother had every intention of nursing her baby, and fully realized the\nadvantages*\n6* Mother with a two-day old babfr. Asked her how she was feeling and told about\ncoming ln for the post-natal examination*\n7* Mother with an eight day old baby* Mother immediately asked the nurse about\ninverted nipples. The nurse started to talk about breast feeding the babfr and its\nvalues; 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\nwas not being nursed, and that they were making arrangements for manual expression of\nthe milk. Here was a case where the nurse (public health) was not fully informed.\nShe had not checked with the nurse on the ward nor had she looked at the chart. She\nnight even have gotten more particulars from the mother before starting in on her\nlittle scolding.\n -24-\n8, Mother with a three day old baby. The nurse seemed to be acquainted with the home\nconditions. Apparently a family of six lived in one room. The father had Just been in\njail for a month. Mother said that he had returned home the day she came in. Nurse asked\nwho was looking after the children, was told that the Catholic Welfare had taken them*\nNurse asked if they would keep them for two or three days after she went home* Mother\nsaid she thought they would. Nurse said that she would phone the Welfare about this*\nThis phone call was later made* It seemed to me that this was hardly necessary because\nthe mother had made all the arrangements herself*\nThis completed the visits on the ward. It seems that it is the policy to visit\nat least once during the stay in hospital. The patient stays f*om eight to ten days.\nDid not check to find out the information which would be sent to the nurse but, presumably\nit would only be the birth registration or, if there was a special need, some Information\nwould be sent to the District Nurse for follow-up*\nIn the afternoon observed in the pre-natal clinic. Miss Webb was the public\nhealth nurse. Miss Webb's office was an outside office next te the two used by the\ndoctor for interview and for examination. In order to get to the doctor's office it was\nnecessary to go through Miss Webb's office. Also the scales for weighing were in her\noffice. When a mother was called in to be weighed she might go back to the hall to wait\nor she might go through to the doctor. When she was finished with the doctor she mama\nback through Miss Webb's office to the hall to wait for her Interview with Miss Webb,\nThe public health nurse sees all the patients who attend the pre-natal clinic.\nThere is usually a volunteer who weighs, keeps the records straight and sees .\nthat the mothers get in to the doctor In order. The volunteer was absent and a student\nwas acting. She was very efficient* One could not help but feel that had it been a lay\nperson it would have been another obstacle to the mother telling her problems to the\nnurse* (The scales could have been elsewhere,) As it was, the problem of so many people\ntravelling through the office was a very great hindrance.\nThere seemed to be a great deal of emphasis placed on getting the records in\norder and \u00E2\u0096\u00A0\u00C2\u00BB*\u00E2\u0080\u00A2<\u00C2\u00AB\u00C2\u00A3 sure that the appointment card was out and marked. One did not get the\nfeeling that this was going to be a smooth conference, and that the nurse would impart to\nthe mother that she had plenty of time to listen to her and encourage her to tell her\ndifficulties*\nThe conferences were as follows -\n1* Nurse read the doctors notes, said \"Can't find anything wrong with you at all\"* This\nmother was in her ninth month of pregnancy. Asked her if she was resting, asked also\nabout her iron pills* Checked this mother about her crossed knees, spoke about diet and\nthis ended the interview* No notes were made on the chart. It does not seem to be the\npolicy to do this as none were made subsequently. This interview took about a minute and\na half*\n2* The patient sat for many minutes while the nurse was fiddling to get her desk in\norder* Asked the patient regarding rest, appetite, etc. Seemed to me the doctor had\nalready done this. Gave her an appointment to come back*\n3* Mother in eighth month of pregnancy. First remark - \"Can't find anything wrong with\nyou to-day except that you have gained a bit of weight. Are you taking soft drinks?\"\nGave appointment to return in two weeks.\nAt this point the hospital nurse came in to ask publie health nurse if she\ncould get a pair of elastic stockings for a patient. I wonder if this is not rather\ntypical of the type of request which cones to the nurse, the supplying of material\nrelief. I have not seen any evidence of case work yet*\n4. Mother in her ninth month. This mother had had chorea as a child. I later read the\nmedical history. She was an unmarried mother and was extremely nervous in her movements.\n -25-\nShe had just been out of hospital having bean ih for a heart condition. Said to the\nmother - \"Ame you getting plenty of rest. You've got to get plenty of rest. Are you\ngoing to keep your baby?\" And then an appointment was made for the next week.\nIn discussing this case with tha nurse afterwards I was told that this was\nquite a social problem. The girl waa living with her aunt and uncle, she was planning to\nkeep her baby, but the nurse was sure that it was not a good arrangement* A few little\nnotes with this social information wars scribbled on a place of paper attached to the\nappointment card. Not a single mention was made of this matter in the folder which\ncontained all tha records used by the doctors and others in the hospital* Hera Indeed,\nwas a ease needing a great deal of intensive case work*\n5* A mother who had been coming regularly. Asked her \"How much rest are you able to get,\nwho 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*\nNurse explained that it was no different when she was in that stats than at other times*\nIf they nauseated her generally, they might then*\n6. Mother ln her eighth month. Opening remarks - \"Did they take some blood from you\nto-day?\" Then nurse read the doctors motes, partly aloud* \"Are you having some trouble\nwith constipation?\" Then she went over the doctor's suggestions* \"Your diet is Improving,\nare you taking some raw vegetables?\" Then she gave some suggestions in regard to constip- ,\nation and referred to the training of tha baby* Said that it could be done at two months\nby sitting it on a small pot*\n7* Opening remarks - \"Did they take some blood froa you to-day*\nEverything is fine*\" Gave her an appointment to return*\nAre you feeling alright?\n8* Mother in seventh month. Wanted her to go for an appointment at x-ray. (It seems\nroutine that pre-natal cases are given a chest x-ray. This is usually done at the time\nof their first visit* (It was not convenient for this mother to go to-day so it was\narranged that she would on her next visit*) \"Are you feeling alright* Are you getting\nenough rest?\" \"How about the other children*\" This mother had high-heeled shoes, but\nnothing was said about this. It was noted also that there were two or three other\nmothers wearing very poor footwear, considering that they were so far on in pregnancy*\nThis fact was never mentioned.\n9. Openeing remarks - \"Well Mrs, Casey, can you go up for x-ray to-day?\" She then\nasked her about her diet and weight and gave instructions for going up to tha x-ray\ndepartment. As a natter of fact, for everyone who had to go to x-ray department quite\nelaborate Instructions wars given, taking time and effort.\n10. A woman in her ninth month, who had on very high heeled shoes. \"You most get plenty\nof rest until you come in.\" Gave warnings about what the signs might be when she would\nbe starting labour and what she should do in relation to coming ln to hospital.\n11. An unmarried mother whose baby was due. Told her to come back a weak from to-day if\nshe was not in hospital before.\n12. Mother in her ninth month, \"Everything is find, soma back ln two weeks,\" Mother\nreminded the nurse of tha x-ray. Nurse gave instructions about going. The mother was\nunder-weight bat she did not ask her about her diet*\n13. a mother who was working. Nurse checked her address and asked her if she would go\nup for x-ray, gave her tha slip and instructions. Alma gave her an appointment to coma\nback four weeks from to-day.\nAfter tha mother left the nurse told me this was a special case. They were not\nsure that this mother was married, thought that she was living as a common-law wife.\nThey also knew that she had another child, but no one seemed to know where it was. Here\nwas another case for Intensive social work and nothing being done. Just a few notes\n -26-\nwere scribbled and attached to the back of the appointment cart.\n\u00C2\u00B1her \u00E2\u0084\u00A2 i^W ^^J\"^ \"*e TO,ad haTe liked *\u00E2\u0080\u00A2 >\u00C2\u00AB\u00C2\u00AB- \u00E2\u0080\u0094 70\" earlier\". (The\n\u00C2\u00A3^ L^S-tJf \u00C2\u00A3\u00C2\u00A3..wvA Th^,the m,r8e dl800T\u00C2\u00AB\u00C2\u00ABi \u00C2\u00AB** th. mother had just come\na University student. This was a very intelligent mother. Nurse filled out toe appoint-\n%\u00C2\u00A3 ^t^t1S:S:din! ^^riulr0,, pLLL'' 6m h\u00C2\u00AB the hea\"\u00C2\u00BB depart.** booklet,\n^ ^LTttTSS I ^f^ \" \u00C2\u00AB\u00C2\u00BBe had any worries. Gave her an appointment to return.\nShe was not told that a district nurse would visit*\n15* New mother. Prinapara, in her fifth month. Opening remarks - \"You did not get in\nnearly early enough to see us.\" Asked if she had had any other pregnancy. Took tha\ninformation for the appointment card, asked her what her husband did, gave her an appointment to come back in one month.\nThese were all the conferences I listened to. They occupied about an hour and\na half of time. At this point, Miss Nettleton came and asked if I wanted to go on the ward.\nthe wards.\nVisits with Miss Nettleton re V.D. cases which had been referred and were on\n1* A woman who was getting penicillin. Nurse read the chart but there was not a sufficient\namount of information on it. When she interviewed the mother it was rather obvious that\nshe was probably a private patient. Woman remarked that \"it just gets on ny nerves.\"\nThere was no follow-up done on this. It seems it is routine when such cases are reported\nand they are on penicillin that the nurse must make out a slip and send it in to the\nProvincial Health Dept. The private doctor had to fee contacted in this case before the\nnurse could do anything more,\n2. Found that the case had been discharged a week ago,\n3. Found also that the patient had gone home*\n4. An old man about seventy-one who had been referred for placement. In talking to the\nnan it was found that he was quite an independent chap, that he was going back to the room\nwhich he had left before coming in and that he had plans to apply for the aid age pension\nwhen he got out. There was obviously no particular reason why anyone should be concerned\nabout arranging placement for hia*\nAfter visiting with Miss Nettleton we went back to the office.\nThursday morning, observed in the chest clinic with Miss Bird. Clinic was\ngoing on at the time of arrival. Here too, the nurse seemed to be very concerned about\ngetting her papers straight and records in order and appoihtments made, etc. There was\nconsiderable getting up and running around. Her desk was in the hallway almost under the\nstair case. There was very little opportunity, in fact there was no opportunity for\nprivate conversation. A volunteer sat beside her. This volunteer ran errands and marked\nappointments on the card.\nConferences in chest clinic\n1, Woman came to get appointment for lipiodol. Nurse explained what lipiodol was and\nwhy they were giving it. However, her esplanation was not very good and it most certainly\ncould have been given by another nurse. Quite probably it was given already by the doctor.\nThe patient was reading parts of her report as the nurse was making out the slip, A\nsecond patient was standing reading over her shoulder. Nurse gave her the instructions\nto go up for tha x-ray,\n2. An x-ray appointment for a patient and date given to return to get report. Weight\nwL, chec^andasked where she was working. It seems *\u00E2\u0084\u00A2^_^* \"*\" EFEL\u00C2\u00B0Z5\nin for examination she is given an appointment to go upstairs for an x-ray and then date\n -27-\n^ J! \u00C2\u00A3?L?l t !!\u00C2\u00B0r \u00C2\u00A3 read* He does ** 8e* th* *-*ay \u00C2\u00AB1\u00C2\u00BB before the patient\ncomes in to get her report. Thus all negative cases come in also. pa*xen*\n3. A patient who had formerly been in the sanatorium. Discussed weight and exercise,\n!f hTL^t18 \u00C2\u00B0rdf S\ **?**\u00E2\u0096\u00A0\u00C2\u00AB* \u00C2\u00ABi~ to return in two months. Thif^aUeit\nhad had exercise increased. No notes were made on the chart in this case or any other case*\n4. A woman, an older patient. Given an appointment for x-ray and told to return for\nreading of the report.\n5. An older man who had formerly been in a Sanatorium and quite probably was having\nincreased activity. Nurse did not know the man's name although the doctor had given it\nto her. She called a student and said \"would you weigh this man.\" The patient then came\nback and the nurse continued questioning. He said he had had a skin test. Nurse said\nshe would give hin a note for the private doctor. The patient had already stated that\nthe private doctor had told him to let him see the.test in 48 hours and it did not seem\nthat a note was necessary. However, it was a routine matter and the nurse told the patient\nthat the doctor would report the result of the test and that he should bring this paper\nback with him when he came next week. An appointment was given for that time. Her parting\nwords to the man were - \"You give that to your doctor and show hin your arm.\" Much as\nthough he were a little boy. This was an intelligent patient and he did seem to think or\nthat all of this was a little bit absurd. She then said - \"Don't forget to go to your doct\non Saturday,\n6. A patient who had formerly been in the Sanatorium, The nurse read over the doctor's\norders and as she was reading them just seemed to look to the patient for confirmation\nthat everything was o,k. An appointment was given for x-ray and she was to return in a\nweek.\nMy impression of this clinic seemed to be that the nurse is just used to give\nappointments, There did not seem to be one thing that a clerk could not have done or as\nfar as the professional side is concerned, would not already have been done by the doctor,\nor could not have been done by another nurse. In fact, there was nothing done that\nwould have made any difference if omitted. 1\nThen went down to the Diabetic clinic where Miss Howe was the public health\nnurse* Walked into her office where she was sitting on a stool at a desk interviewing\na patient* There were four other patients in the office at the time. Her room was very\nsmall, tso of these patients were sitting, the other two standing, they were Jewish and\nthey were all talking in Yiddish*\n1, An old nan and aha was explaining to him when he should come back and that he should\ntake a bottle to bring in a specimen. She put his name on the inside of the bottle and\ngave it to him,\n2, A woman who did not seem to having any difficulty, A return appointment was given*\n3, A man who apparently had just had diabetes diagnosed. A V.O.N, had been in and\ntaught hin how to give insulin and he was now able to give it to himself. The nurse made\narrangements for hin to get special assistance in the way of diet* Apparently it is\ncustomary for groceries to be delivered once a week from Simpsons* In order to do this jl\nshe would have to send a note to the district nurse who would call around. The\nWelfare Dept* would then be contacted and they would call. She gave hin a new needle for\nhis hypodermic*\n4* A Jewish woman. A doctor had ordered that she the dietitian. When she sat down with\nthe nurse she immediately started talking about her diet and the nurse said that she would\ntake her to see the dietitian. The nurse gave her a re-appointment. In this case the r\non]\u00C2\u00A3 thLTthat was dona by the nurse was the giving out of the appointment, and the patieni i\nhad waited twenty minutes just for this*\n -28-\n5. An older woman who was now not taking insulin. Nurse said - \"AaVe you gaining\nweight again?\" Re-appointment was given. The patient went down to the Emergency to get\nher medicine and while she was there the nurse went to order an ambulance.\nAsked the nurse about the cases she referred to the District. She sends a slip\non all new cases and then any which have a special problem. When it is a case of teaching\nto give insulin she contacts the V.O.N. Here there does seem to be a rather strange\nsituation. The patient may be diagnosed diabetic. Instructed in the out-patient's\ndepartment if he has to have insulin. V.O.N, nurse goes ln to teach him to give insulin.\nFollow-up is done by the district nurse. Would it not be much more logical to have tha\nDistrict Nurse make the initial contact and teach the patient to give the insulin?\nIn the afternoon attended the regular monthly staff meeting of the Hospital\nHealth Services group. This is held in the waiting room at St. Michael's Hospital.\nMiss Carroll in the chair. She asked me to tell about the Study. Following that, their\nmeeting consisted of going over the holiday list and checking on two or three routines.\nWould question very much if very much educational material is put across at these\nmeetings.\nJune 4. 1948.\nVisited Hospital for Scik Children, Hospital Health Service Dept. About five\nnurses in one small room. This room situated in the centre of the Out-patient Dept. In\nthe clinic itself there is no space for the public health nurse to be present at the time '\nof the doctor's examination or to interview parents. Apparently there are one or two\nclinics which the nurses are on the spot. For the remainder, the doctors supposedly,\nbring 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\nsurgical equipment, home dressings, etc. The hospital health service also looks after T.B.\nadmissions to Sanatoria. Tries to get the consent from the mother and notifies the San.,\nor if there is not a bed there, the Convalescent Home. The Convalescent Home wound send\na car. Then, if the mother should refuse to have the child go to hospital, a note is\nsent to the district nurse for her to go in to see if anything could be done. If she\ncannot persuade the mother then the district medical officer is called in. And if he\ncan't do anything about it, the problem is referred to the Director of T.B. Control. If\nit is still unsettled the matter can be taken to court. It does not seem to be the policy\nto call in any social agency, except in the case of placement.\nThe nurse stated that one-half of the job in the Hospital Health Service, is\nclerical work, a great deal of which could be done by clerical assistance. One nurse who\nhad just been in the Department for three or four days was sitting at a desk copying\ninformation from ear, eye and nose and throat charts of cases which had been seen by the\ndoctor at the clinic. She uses her discretion about the ones which should be referred to tl\nthe nurse in the district. She had not seen the case or talked with the mother. This was\na purely clerical job and not one which would be very stimulating to a nurse with her\ndegree and a great deal of experience. This happened to be Miss Frances Pearl,\nAs it did not seem to be a day that I could have very much opportunity to sit\nwith the nurse when she was conferencing, I made arrangements to return on June 21st,\nThis was later cancelled because on that date they were taking on three new nurses.\nFurther visits to the Hospital Health Service will be made later on in the year.\n -29-\nCAHAPIAN ASSOCIATION OF SOCIAL WOftKmg \u00C2\u00BB MEDICAL SOCIAL SERVICE INSTITUTE.\nJune 8-11. 1948\nTh18 Institute was conducted every morning from 8.45 to 10.20 a.m. during\nthe four day session of the Social Work Association annual meeting in Hamilton. The\nInstitute was conducted by Miss Margaret Johnston of the University of British Columbia.\nAt the first morning she stated some of the principles of social work.\n1. Social worker recognizes the right of the individual to make his own plans,\nprovided that it comes within the limits of safety in the community.\n2. Social worker recognizes that all behaviour is motivated.\n3. Social worker recognizes that the patient is of the family. He is not a unit, a\ncase, etc* She stated that we all have a common interest in the person, to help the\nindividual find a healthy, a satisfying life.\nDiscussion - This institute was attended by over forty workers engaged in some form of\nsocial work. A great many of them were D.V.A. There were some who had not had any\ntraining in social work, some were nurses mho were endeavouring to do a social work\njob without any special training apart from their nursing. Others were nurses and also\ntrained social workers. It was very interesting to hear the discussion of all these\ngroups. Because of the diversity of the class it was necessary to give only the\nelementary principles of medical social work. The discussion on the first day centred\naround the questioh - \"What is the medical social worker for?\" \"What is her function?\"\nHer functions are -\n1, She gives case work service to the patient. She does those things related to his\nillness. Those things which are related to other problems are for referrals to other\nsocial workers in other agencies.\n2, She is part of a team. The direction usually comes from the doctor. He has in\nmind certain treatment and the case work may be the tool he uses in achieving the final,:\nresult.\nIn the matter of referral it was decided that the referral should usually\ncome from the doctor. The nurse may recognize the problem, she may discuss it with\nthe doctor before she refers it to him or referral may come from the public health\nnurse in the district and sometimes from the patient himself. It was stressed,\nhowever, that the doctor must know about the referral and it is better when it does\ncome directly from him. If problems are handled without the knowledge of the doctor,\nthen he is not being educated In the use of the medical social worker in treatment*\nDr. Winfield, Psychologist for the Board of Education, Toronto, stated that\nthe public health nurses do a lot of medical social work in the schools. Felt that he\ndid not really understand the meaning of medical social work. This confusion must\nresult because the medical social worker and the nurses are themselves confused about\ntheir own work. The work of the nurse is that of health education and she should have ;\nsufficient knowledge of social work to recognize the problem and to know to whom and\nhow to refer it to the proper worker*\nIn summary, Miss Johnston stated that the main function of the medical social :\nworker is to do case work with the patient. The patient who comes to the hospital or |\nto the health clinic may be unaware to the extent which his social problems may be\nintensified by his illness. Joint planning must begin at the point of referral and\nit must be fitted into the total social plan. How far does the medical social worker g\ngo? How long is the feeling, how far can she meddle in personal problems and deeply , \u00E2\u0096\u00A0\nlaid patterns of personality. She can only know this through professional training\n -30-\nand experience. It is not just common sense. How far she can go in treatment depends\nIZL \ ^\" * \u00C2\u00B0n the Patient and \u00C2\u00B0* her problem. 3. on how far the doctor\nwants her to go. 4. on co-operative planning. This co-operative planning concerns the\ndoctor, the ward nurse, the public health nurse and to a lesser extent, other personnel\nIn the hospital and other agencies in the community. As yet, we are ohly scratching\nthe surface in co-operative case work. \u00E2\u0096\u00A0\nOn the second day, the session started off with a summary as above, and then\nthe meeting was thrown \u00C2\u00A9pen for discussion. Examples were invited of the type of work\nwhich is done and discussion started out witji the things a bed-side nurse could do\nInstead of a social worker. It was suggested by one person that the bed-side nurse\ncould arrange with the V.O.N, for injections, could notify relatives in case of serious- >\nly ill patients. Miss Johnston stated that a criteria for decision as to who should do\nthe job night be\nWould this have to go on if there was no social work department in the hospital. She\nfeels 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,\nand in this place and for this reason\" it has to be done this way. This does not mean\nthat at a later date it might not be changed. Progress comes slowly but surely. The\nthird thing which the bed-side nurse might do is to arrange for transportation.\nDiscussion 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\nresponsibility between the ward nurse and the medical social worker. If the case is\nknown to the social service department then it would probably be best for the referral\nto be made through them. If the case is not known to the social worker then it could\nbe referred directly by the nurse on the ward.\nThe matter of social admitting was discussed. In some departments all new\ncases are automatically referred to the social worker. It seems that this practice\nstarted in the early days because they were not getting the early referrals. This\nplanning for tha automatic pick-up of problems breaks the basic principle of referral\nby the doctor and it is rather presumptuous to attempt to do this. This method also\npins the social worker down to being in every clinic and to see every patient. It was\nadmitted that there are certain types of illness for which every patient should be seen,\nfor example, tuberculosis and venereal disease. But it was felt that many medical padtioa'\npatients do not need to be referred to the medical social worker.\nOne worker brought up the matter of disciplinary problems among the tubercul- -\nous. Apparently she was engaged because it was felt that she could handle those cases\nwho were signing themselves out of hospital early or who were going off for days at a\ntins. Miss Johnston referred back to one of the principles of social work. All\nbehaviour is motivated, and asked - \"why is the patient showing this kind of behaviour\".\nCertainly there were cases for the social worker to handle but perhaps not in the same\nlight as the administration in the hospital at first engaged medical social workers.\nIt is the function of the medical social worker to find out the reason why the patient\nis leaving the San. Let him talk it over, she may serve as a steam valve and help him\nto accept the rest gradually. She also has a function beyond this. That of interpretation back of the doctor, the nurse, the administration and others*\nOn the third day a panel discussion on \"Relationships between the medical\nsocial worker and the nurse\" was held. Personnel of the panel - Chairman, Miss Margaret\nJohnston. Discussion, Mrs. Richardson of the D.V.A., Miss Clarkson, English Almoner,\nMiss Tennant, Director of the Medical Social Department of the Montreal General Hospital\nand Miss Creelman*\nMrs Richardson started off the discussion with the relationship between the\nmedical social worker and the psychologist. She pointed out that in any team, the\nfunctions must over-lap to some extent and we must not be afraid of that over-lapping.\nMy function on the panel was to bring out the relationship between the medical\n -31-\nsocial worker and the public health nurse. The following is a summary of my statement -\nMore and more in the public health field we are beginning to realize the social aspects\nof disease. We have long neglected them. We know that a high percentage of tuberculosis\nand venereal diseases have such problems and these two diseases are two of the most\nimportant problems in public health. The functions of the public health nurse are briefly\n1. the nursing eare of the sick in their homes.\n2* participation in measures for the prevention of disease*\n3. education of families in matters of health*\nWhat 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\nshe studies public health subjects and psychology, sociology, mental hygiene and has some '\norientation to social work. It depends on the university in which she studies as to the\namount of this orientation. It also depends on the university in which she studies as to\nthe type of mental hygiene instruction which she receives*\nThe 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\n(a) recognize the social problems, (b) know how and to whom to refer the problem for\ntreatment*\nI believe that the medical social worker might also be used as a consultant on\nthe 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\nhas recently been published - \"The Rehabilitation of the Patient\", by Mrs* Ellidge, ln\nwhich she has a chapter on the medical social worker as a consultant. The following\nparagraph is, I think of interest -\n\"When the medical social worker acts as a consultant in an organization she uses her\nknowledge of medical implication and her case work skill to advise other persons in the\nagency oh medical social problems. Difficulties in accepting the need for medical care,\npersonal reactions to physical impairment and its effect on the service which is being\noffered and so forth. She may provide such consultation services as a part of in-service \u00E2\u0096\u00A0\u00E2\u0096\u00A0\u00E2\u0096\u00A0\ntraining for a staff of vocational counsellors or nurses. This includes discussion of\nindividual problems through conferences in which the staff worker brings records for\ndiscussion, 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\nnot she provides direct service to individuals in these programmes is Influenced by the\nscope of the agency services, the availability of case work services in the community\nand the nature of the problem.\"\nThere will be over-lapping, but as Mrs. Richardson says, we need not be afraid\nof the scene if we sit around a table and work out our problems together. Whether they\nare problems of general policy or just one case that we are deciding who should handle\nthe problem, our questions must always be \"what does the patient, or the family, or the\ncommunity need.\" \"Who is best prepared to help meet that need\"? and, basically, what\ntraining or preparation does the individual worker, nurse, medical social worker, etc.,\nneed to carry out her function.\nMiss Clarkson then discussed medical social work as performed by Almoners ln\nEngland, and also told of the training whieh is given.\nMiss Tennant, Director of the Medical Social Service of the Montreal General\nHospital, gave her views as a nurse who had taken social work training. She stated\nspecifically that the two years is absolutely essential, even for the nurse, before she\ncould be qualified to do medical social work*\n -32-\nOn Friday there was another panel to consider relationships between the\nmedical social worker and the doctor. Two doctors entered into the discussion -\nDr. Bailey, Psychiatrist at Sunnybrook Hpl., and Dr. John Patterson who is in general\nmedicine and is also Director of the Chest Unit at Christie St., and at Sunnybrook.\nMiss Johnston, as chairman, threw out the following question - \"What does the doctor\nexpect of the medical social worker? What cases does the doctor refer to the medical\nsocial worker? What does he think does not belong to the medical social worker.?\"\nDr. Bailey started out the discussion on \"What to expect of the medical social\nworker\" by stating that she must consider herself a part of the team. The medical\nsocial worker can go out to find out something about the patient as a person. She\nshould never work on her own. Dr. Patterson started out with the statement that the\nmedical social worker is to do the work the doctor Is incapable of doing. There are\nmany cases in which he cannot get to the bottom of it all. The doctor who does not try . ,\nto find out all he can about the patient is not doing his job. In general medicine not\nall cases need to be seen by the medical social worker. It is not the job of the\nmedical social worker to explain treatment. That is the job of the doctor. If, for\nexample, a patient has been told about thoracoplasty and he still is uneasy about it,\nthe medical social worker should tell the doctor about this uncertainty on the part of\nthe patient, and the doctor could then follow up his explanation.\nThere followed some discussion about a summary of the medical social workers\nfindings. Dr. Bailey felt that all the information which the social worker put down in\nwriting should be included in the doctor's folder. Dr. Patterson,on the other hand,\nfelt there should be a summary. He stated that doctors would not read any long\ndiscourse.\nThe definition of a specialist was given as \"A person who knows more and more\nabout less and less, until he knows everything about nothing.\"\nIt was necessary to leave before this panel was completed. The institute was\na very great success and I believe has laid the foundation for a better understanding\nof the medical social worker and her function in the hospital and in the health field.\nThis foundation of better understanding must be followed in some active way. Perhaps\nat some future date we might have something in a Canadian Nurses Association workshop onj\nthe relationships between the medical social worker and the nurse. The time would soon\nseem ripe to bring this up for discussion at least*\nJuly 11th. 1948\nPrince Edward Island\nFollowing the meeting of the Canadian Nurses* Association in Sackville,\nJune 28 to July 1, motored to Prince Edward Island on July 2nd, taking with me the\nthree nurses ffrom Toronto, Miss Wallace, Miss Fair and Miss Sneddon and also Miss\nWright from British Columbia and Mrs. Bennett, Chief Nursing Officer, Ministry of\nLabour, Great Britain. We arrived at Charlottetown at lunch time. After lunch took\nthe three Toronto nurses to Cavendish. Frieda dnd Miss Edda MacDonald who conducted\nthe Workshop, School of Nursing of the Future, came along for the ride. It was a very\nwet day and the roads were muddy. Had a lot of fun coming home. That evening I at\nattended a short meeting of the Executive Officers of the C.N.A. The officers who were\nwith the Executive last year all were very tired. The meetings in Sackville were grand 1\nbut must have been very hard work for those who were responsible* On Saturday, July\n3rd, we had an all day Executive meeting at which the committees, the chairmen and\nmembers for the coming Biennium were appointed. Following the meeting in the afternoon,\nthere was a tea* Government House which I attended for a very short tine, and then spen\nthe rest of the day with my relatives. Sunday was devoted to social activities,\nbeginning with a luncheon at Dalvay on the north shore. The executive were the guests\nof the provincial government on this occasion. After luncheon at Dalvay we motored\n -33-\nto Stanley Bridge to the home of Chief Justice Thane Campbell. I have never passed\nthrough more beattiful scenery nor have I seen a summer home in a more picturesque\nsetting than at Stanley Bridge. All in all, it was a very delightful day. Prescott and\nFrieda came along. On Monday, July 5th, I was to see Miss Mona Wilson of the P.E.I.\nHealth Department. However, she called me to say that it would not be as convenient a\ntime as the following morning. Saw her on Tuesday and arranged to see the nurses as a\ngroup at the first convenient time, as it was necessary for me to go to Halifax on\nTuesday and return Wednesday. I saw the nurses on Thursday morning. Miss Wilson had\ntold ae there were eight nurses, however, only four were there - Miss Wilson, Miss Ross,\nMiss Beer, Miss Cox and Miss Wheeler. Miss Wilson had neglected to ask Miss Tate. I\nexplained the survey and asked if they would complete the Job Analysis Questionnaires\nand the School Nursing Service Questionnaires. It seemdd very difficult to arrange with\nMiss Wilson a time when it would be convenient to come back. Saw Dr. Keeping on Saturday\nand 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\ngoing on until the end of July, and as nurses are going on holidays the first of August,\none time would seem to be about as good as another. Dr. Shaw has been conferring with\nthe Minister of Health and Welfare in relation to accommission to be set up for the\nprovincial survey initiated by the Federal government* Told him that I thought nursing\nshould be represented on that committee. He had not planned on that. However, other\nnurses approached him and it seems that now it is most likely that a panel of names will\nbe 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\nwith me Mrs. Creighton and Mrs. Hamilton and Carol who had returned to Charlottetown with\nme on Wednesday*\nWent with Dr. Baillie in the morning to see Dr. Morton. At 2.30 p.m. met with\nthe Provincial Consultant Committee in the offices of the Provincial Department of\nHealth. Dr. Robertson was in the chair. Present - Miss Shore, V.O.N,, Miss MacKenzie,\nProv. Health Dept., Dr. Morton, Dr. Simms, Dr. Bent, Dr. Laurie, Dr. Baillie and myself.\nDr. Baillie started by explaining the background and the purpose of the Study\nand the desired results. Discussion then centered around the major public health problems\nin the province. It was stated that tuberculosis was the first problem and that probably\n75% of the time in the field was spent on tuberculosis. Apparently the average private\npractitioner reports cases of T.B, and then proceeds to forget about it. This apparently\nis quite acceptable to hin and the Health Dept. likes to take charge of the case. V.D.\nwas given as a second major problem, chiefly because personnel are not trained. There\nseems to be quite a feeling of lack of training in this field. Public Health men felt\nthat they should be able to give advice through the private practitioner and that the\nlatter is now seeking this advice in V.D., the same as he has done in the past with T.B.\nThe third problem - infectious diseases, - it was felt very definitely that\nthe public health doctor is not trained in infectious diseases nor venereal disease nor\ntuberculosis. It seems that ln Nova Scotia one of the requirements of the appointment\nof divisional medical health officers is that he has had some experience in a Sanatorium.\nPreventive Mental Hygiene was mmntioned as a fourth prblem, and plans are now\nunder way to build up this service. A provincial psychiatrist has been appointed and\nthere will be two other psychiatrists and psychologists. The details of the program\nhave not yet been worked out. I asked what part the nurses would have and as yet that\nhas not been discussed. I expressed the opinion that it would be too bad to take this\nprogram away from the nurses, that they should be the ones to do the follow-up in the\nhome. There seemed to be agreement on this point. In fact, most of those present were\nwhole-heartedly in favour of the generalized program. Dr. Robertson rather favours the\nidea of specialists in venereal disease work but neither Dr. Simms nor Dr. Bent seemed\nto agree with this. Miss MacKenzie hardly ever expressed an opinion. Dr. Robertson \u00E2\u0080\u009E, jl\n -34-\nftt 1*1 ^S!it*Sirr^hi8*?ta5 ^at ** th0,,ght P\u00C2\u00B0ssil>^ ^ey could train their own\nnurses without them taking the University public health course. Later on, Miss Shore\nS^Sl^ta^^ felt that even nurses with a public health course were not\n^!q^ L ^ r J\"*?**!} WOrk- She sald ***** the n^ses are trained to do things,\nbut that when it comes to teaching the people they fall down. There was some discussion\nof school examinations and it was stated that they were used as a stepping-stone to get\nInto the home. The Provincial Dept. personnel consider that the value of such examination!\nby 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\nthan for any other service. It seems that this is what has been sold to the public and\nDr. Robertson feels that we are now going to have to go out to try to unsell some of our\nideas, and that school examinations is one of these. It was stated that the health\nprogram in the normal schools has been greatly improved. The dental-program is one for\nwhich there is a very great need. At the present time there are two travelling dnntal\nclinics, but they cannot keep these running all year because of lack of personnel. These\nclinics so far, have been for school children only and children fron the ages of six to\ntwelve have the first choice. Dr. Baillie Introduced the question of records. It was\nstated that these are kept to a minimum for the nurses. There is however, a great need\nfor statistical clerks. Dr. Simms said that when it comes to writing the annual report\nhe must sit down for three solid weeks. Apparently the doctors have to get out their\nown statistical information* Maternal and pre-natal program was discussed briefly. In\nonly one area does the nurse carry maternity cases and that is in Baddeck. It was stated\nthat family doctors do not report pre-natal cases readily. This has not been encouraged\nbecause 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*\nIn relation to cancer, the services are pretty well localized in Halifax where\nthere is a cancer clinic in the Victoria General. All treatment facilities are there.\nThere seem* to be a very good correlation of health and welfare. Social workers operate\nfrom Halifax. Mr. McKinnon, who is the director of child welfare, works very closely with\nthe Health Dept. I feel, however, from the discussion that the idea of welfare is chiefly\nmaterial relief and that possibly there is not a great deal of case work involved. It\nseemed to be the general opinion that the great problem is lack of nursing personnel. It\nwas definitely recognized that the nurse is the basis of the public health program. The\ndoctors also feel that there is a great need for more public health divisional men. They\nare concerned that doctors are not entering public health*\nJuly 13th. 1948\nMet with Victorian Order of Nurses at 8 a.m. Explained the survey and left the\nJob Analysis forms for them to complete. Miss Shore, the nurse in charge of the V.O.N.\nmost co-operative. Arranged to visit some of their baby clinics. Apparently the city\ndoes not run any, the V.O.N, operating all in Halifax. Next, went to see Miss Crosby\nwho is the acting supervisor for the City Health Dept. She and her nurses have an office\nin the basement floor of the Dalhousie Clinic. Mr. Morton's office is in the City Hall.\nMiss Crosby had not been notified that I would be coming. However, she was very nice and\nI made arrangements with her to return to speak to the nurses to-morrow morning. Returned\nto the Dalhousie clinic in the afternoon to observe a pre-natal clinic. This clinic is\noperated in the Dalhousie clinic building with a V.O.N, nurse in charge. Mrs. Hackett\nwas the one in charge and as she has been away from pre-natal clinic work for a little\nwhile she was somewhat unfamiliar with the routine. Two of the affiliating students are\nassigned to the clinic. This happened to be Dr. Atlee's clinic, but he did not appear.\nfhay were also one doctor short. There seemed to be a great many patients. They bring\ntheir little blue card if they have been to the clinic before, bring in a specimen of\nurine, are weighed and measured by the students and have their temperature taken by the\nstudents and then go back to the waiting room to wait for the doctor. The V.8.N. nurse\nis responsible for the administration of the clinic. She does not have any time to\nconference with the mothers. This does not seem to be planned at all. She makes a\nA\n -35-\nU!lf ^^4^ ^z**?^8 *\u00C2\u00BB a little bla<* *>ook and also notes the temperature and\nweight. This is taken back to the V.O.N, office and the district nurses look over it and\nif they have a patient, transfer the information to their records. The V.O.N, nurses do\nall the follow-up from the pre-natal clinic. An office worker from the Salvation Army\nHospital 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\nthey have all the previous clinic information. This seems to be aduplication of effort.\nThere should be some way by which that record could be transferred if necessary. It is\ndoubtful if all the information is of value or even read. At the same time a clinic was\nsupposed to be going on for V.D., and T.B. However, the doctors do not arrive at these\nclinics until four o'clock. It seems to be pretty well taken for granted that all of\nthese are doctor's clinics. I do not see much evidence of nurse conferencing. It seems\nthat Dr. Beckwith's clinic oh Friday night is a very popular one and I was advised to\nreturn to it.\nBefore lunch I had an opportunity to talk to Miss Fraser, who was a nurse in\ncharge of the Dalhousie clinic. She told me that this clinic is the Out-Patient Dept,\nwith special emphasis on public health. It acts as the Out-Patient clinic to various ^\nhospitals and takes patients from the country and province. It is part of Dalhousie\nUniversity. There are three public health nurses on the staff. One of these nurses has\nhad a course in supervision. I do not think that Miss Firaser herself has had any public\nhealth training. Before the City Health Dept. was organized these nurses and the V.O.N.\ndid most of the visiting done in the city. They still follow a number of cases but these \u00E2\u0096\u00A0\nare for the purpose of teaching the student nurses who are affiliating. They have\naffiliates from the Hospital Infirmary and the Children's Hospital. I believe also, that\nmedical students go out into the homes visiting with the nurse. The student nurses come\nfor two months, get their out-patient training and visit all the outside organisations\nand are taken to visit selected cases. They also go with the psychiatric social worker\nattached to Dr. Jones' department. They also make some visits on their own. They are\nusually pretty well through their third year in nursing before they take this affiliation,\nalthough they have some earlier. Not all students from these hospitals are taken. Up to\ntha present time, the Victoria General has not had any affiliation. One of the public\nhealth nurses is always present at the child welfare and pediatric clinic, at the chest\nclinic and at the V.D. clinic and they fill in at all the other clinics when necessary.\nCases coming to these clinics are referred to the City Department except those which are\nkept for student visiting. Also saw Miss Watson for a few moments. She is a social\ninvestigator for V.D. Cases and works directly under Dr. Morton. Dr. Morton stated that\nhe did most of the V.D. work himself. Miss Watson has not had public health or social\nwork training. It seems that all the V.D. work is done by Miss Watson and Dr. Morton.\nThe public health nurses apparently do not carry any cases* Will find out more about this\nwhen 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\nin hospitals. They have no nurse inspector of hospitals in Nova Scotia. Miss Watson was\na private duty nurse who, following her work in private duty had seven years in an office.\nAfter the war she went back again to private duty and then was appointed as Registrar,\nShe has had a good background for the routine work but I doubt that her understanding of tl\neducational policy is very great.\nJuly 14. 1948\nMet with the nurses of the Health Department. Ten are on duty, one nurse came\nback from her vacation to the meeting. She had heard that I was going to be there and\nwas extremely interested. Very few of these nurses have public health training but all\nseam very interested in the survey and did not make any objections to completing the\nforms. They asked many questions and like all groups, seemed very happy to have someone\nfrom outside come and discuss their problems with them. Have arranged to go out with two\nof them to-morrow. Following the meeting with the nurses interviewed Miss Crosby to\ncomplete the key forms. Miss Crosby is only the acting supervisor. Dr. Morton is\nplanning to appoint someone slse and is thinking of Miss Burgess. Miss Crosby apparent*:\niy\nk\n -36-\ndoes not want to continue and probably is not th\u00C2\u00AB nova\u00E2\u0084\u00A2 +\u00E2\u0080\u009E,!.. . . , . .\ngreat deal of push. P6\u00E2\u0084\u00A2011 *\u00C2\u00B0 do 8\u00C2\u00B0 as she do93 not |jjR a\nWent to see Miss MacKenzie at the Provincial Department at noon. There are six '\n!SwS mHi departl,e^J -*? Breton \u00C2\u00BBlth Miss MacDonald as supervisor and thirteen of\nstaff. Bridgewater, which includes the counties of Lunenberg and Queens, with three staff\nnurses, one of whom is senior. Yarmouth, which includes Yarmouth, Shelbourne and Digby\ncounties, three staff nurses and a fourth, will go on duty in August. Windsor which\nincludes the counties of Anapolls, King, Hants and Colchester and has three staff nurses.\nNorthumberland which includes Picton, Guysborough, Antigonish, Cumberland and part of\nColchester county. They have eight nurses. Miss McCann is the senior and will probably\nbe 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\nColchester county. The sixth unit is the Atlantic which is Halifax county and has one\nstaff nurse. In addition to these, (see list of complete staff), there are three nurses\nwho are clinic service only. Two on the dental clinic and one on the mobile x-ray. These\nnurses have not had public health training. They will take on nurses without public health^\ntraining on condition that they take the course after one year's service. It is their\nhope to have a supervisor in all the Units, but to date, it has not been possible to do\nthis. When a new nurse comes on she is brought into the central office for a few days,\nthen if she has not had public health, is assigned with another nurse. Miss MacKenzie\ndoes not feel that a new nurse without public health should be given a district of her own.\nI am not sure that this policy is always carried out. If she has had public health she\nwill spend a little time with another nurse either in the other nurses* district or in her\nown district. It does not seem that they have very many group conferences, apparently the\nwhole staff were in last May and they do try to have a meeting like this once a year, I\ndoubt very much that very much is done in nursing* They have no manual. Each nurse has\na guide. Asked Miss MacKenzie for this and hope it will be forthcoming. Miss MacKenzie\nstated that the expense accounts and weekly reports are sent to the central office. She\ngoes over these. In the afternoon went to a V.O.N. Well-baby clinic at 139 Yonge Street.\nThis is a room upstairs in a building. Outside there is a notice stating - \"V.O.N. Well '\nBaby Clinic, Weighing and Immunization.\" The clinic Is held Mondays and Wednesdays with\nthe Immunisation Clinic on Mondays. There happened to be no babies while I was there.\nSome times the attendance is two and sometimes as high as forty. I would judge that the\naverage would be around ten to fifteen. They do not have a regular appointment system.\nMiss Tanner was the V.O.N, nurse in charge, has not had public health but is taking it\nnext year. If the baby needs follow-iqp in the home, the V.O.N, nurse will do it. Miss\ntanner stated - \"The city nurses just go in for immunization and the like, they do not\ngive advice regarding feeding,\" She has a Red Cross Worker who pulls the records and makes\nout 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\nand takes that back to the V.O.N, office. Nurses look over it and if the mother is in\ntheir district they will make a note of this on their records. They have the Federal\ndepartment literature and insurance company literature, etc. The records are not taken\nout of the clinic. A mild dicision so far would lead one to believe that there must be\nconsiderable over lapping in V.O.N, and city. Will try to find out nore about this when\nI go out with the respective nurses.\nJuly 15th. 1948 - 10 a.m. went visiting with Mrs. MacDonald, Department of Health Nurse.\nShe took me to one of her schools, St. Joseph's. This is divided into the girl's school\nwith 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\nlarge room and was apparently one of the few who has a room of adequate size. Mrs.\nMacDonald went over some of the duties and the records which have to be completed. There\nis usually a dental survey in the fall done by a dentist ln the Grades 1 and 2. The nurses\nare^esponsible for the follow-up records and making the dental appointments. The doctor :\n -37-\n2fi^^SS2S\u00C2\u00AB? r\u00E2\u0084\u00A2* \u00E2\u0096\u00A0duty *\u00C2\u00B0weighand \u00E2\u0096\u00A0easure' c^\u00C2\u00ABk teeth> *>\u00C2\u00BBs\u00C2\u00B1i*\nS?+*^ *L\u00E2\u0084\u00A2H ^<*\u00E2\u0080\u00A2\u00E2\u0096\u00A0 \u00C2\u00AB\u00C2\u00ABPt \u00E2\u0080\u00A2yms. Mrs. MacDonald does not test hearing, she feels tt\nthat she cannot do this adequately. Mrs. MacDonald does all these tests at one time. Th.\ndoctor follow with a complete examination* For all grades in between 1 and 7, the nurse\n^^ \u00C2\u00AB\u00C2\u00AB/^\u00C2\u00ABitP\u00C2\u00A3Ttly Mrs# MacDonald i\u00C2\u00BB able to weigh and measure all her\nchildren and test all their eyes. In the afternoon I was with Miss Hopkins. She said it\nwas not possible for her to do all this. In relation to communicable disease, the nurse\nmust visit everyjsase. She completes the pink special investigation card and sends it to\nthe office with the daily report. She must then make a return visit to release the child\nfor school. In doing this she gives a card with a statement on the babk that the child\nis free to return to school. If the case is suspected scarlet fever, the nurse takes a\nthroat swab. The sanitary inspector will placard after the diagnosis has been confirmed.\nHe gives no instructions. He removes the placard but the nurse must visit first for\nrelease. These two visits which are essential for all cases of communicable disease,\ngive the nurse a very great deal of work, and when chiokenpox, mumps and measles are\nprevalent,that is practically all she has time for. She must also make these visits for \u00E2\u0080\u00A2\nGerman measles. In relation to immunizations, these are done in the schools. There seems\nto be many slips which have to be sent home. The parents are getting very tired of this\nbecause there are slips from the teachers. It is their policy also to do a booster dose\nevery year. In relation to mental hygiene - if there is a behaviour problem, refer first\nto the school doctor, then talk to the parents. If the child is to be referred to the\nclinic the nurse uses the referral form to the family physician and also she may write\nout an extra history. There is no special form for this. The child is examined and no\nreport is sent from the clinic unless the nurse goes to the social worker in the office*\nThe social worker follows into the heme. The nurse is not allowed to read the chart*\nMrs. MacDonald had three such cases and she never knows if they are under care unless\nshe phones. In relation to tuberculosis, the nurse does the patch test on the children\nand 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\na typed list of the cases by the stenographer. The nurse makes out the appointment Slips,\nand mails.\nIn relation to case loads. The school cases are, of course, the most numerous.\nFamily folders are kept for tuberculosis cases. No family folders are kept for infants\napparently. The nurses receive a list of birth registrations when the baby is six months\neld and she visits regarding immunizations. Pre-natal cases are referred to V.O.N. The\nimmunization visit has a special card, in three parts* (See sample). After the six\nmonths visit, if the middle card has hot been returned to the health office, signiflying\nthat the immunization has been done by family physician or the clinic, the nurse visits\nat one year, otherwise there is no further visit. Tjere are no other records on infants\nor pre-school children. Following our visit to the school, went on one home visit with\nMrs. MacDonald. This was a visit In relation to an eye defect. There were other childret\nin 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\nyoung nurse, she trained at the Victoria General and has worked with the V.O.N. She\nintended taking her public health course but married. I doubt that this visit could have\nbeen better done by anyone trained in public health. Our next visit was an immunization\nvisit. The mother was not at home. A third visit the same.\nIn the afternoon went with Uss Hopkins who is a public health nurse, to see twc\nof her schools. Her health service roons are very small and one of them especially, very\ninadequate. She seems a little more selective in the work which she does. Did not do\nany visiting with Miss Hopkins, as we wanted to go to AfTieville, which is the section in\nwhich the lower class of negro lives, and is away out on Thetford Basin. Dr. Baillie,\nMiss Hopkins and I, went over very rough road at the end of Barrington Street. Our\npurpose in going was because an immunzation clinic was being held out there. When we\narrived, Dr? Rice, the two nurses, were waiting outside the school. The janitress who\nhad the key, had decided to go to town and noe one could \u00C2\u00A9ft in. As it was a very fine, ,\nday, the material was just set out on a rock in front of the school and one by one six\n I- . , I\n-38-\nabout half a dozen children arrived. There were supposed to have been about thirty but\nit was a fine day^for s^ndng. Some adults, mostly young men of the usual listless\nnegro 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\nother immunization clinics a stenographer is taken instead of the extra nurse. The\nstenographer makes out the records and gives the slip necessary. Why it was necessary\nto have an extra nurse here, even if the thirty had turned up, we failed to understand.\nIf the clinic is properly organized one nurse can handle it and certainly it seemed to\nbe a waste of medical personnel. In cases like this it seems to me that the nurse should\nbe able to give the immunization. As Dr. Baillie says, why cannot a standing order be\nmade which will cover it and why all this fuss about legal responsibility. After the\nclinic, Dr. Baillie and I went to the Provincial department to see Dr. Marshall who is\nhead of the new Neuro-psyehlatric Division. Dr. Marshall has two psychiatrists appointed\nand is appointing a psychologist. The idea in relation to mental hygiene is that these |\ntwo psychologists will be stationed in separate parts of the province and it will be the\nbeginning of a travelling clinic. The purpose of the travelling clinic will be - 1. to\nsupervise the patients in county hospitals, (see note following). 2. to act as consultant\nto 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\ntherapy,\nDr, Marshall explained that Nova Scotia is the only province which does not\ntake complete care of its mental patients. There is a mental hospital, the Nova Scotia\nhospital at Dartmouth, but each county has a county hospital which looks after those who\nare not violent. In relation to the feeble minded and retarded children, there is a\nschool at Truro, Halifax is the only centre which has special classes for children in\nschool. Dr, Marshall is not at all satisfied with the way these are operated. We asked\nhim about teaching in the Normal Schools. Dr. Jones, the psychiatrist in Halifax is\ngiving a course in mental hygiene to the students at the summer school at Dalhousie.\nThis apparently is very popular.\nJuly 16th. 1948 - Went out with Miss Cameron, a very shy young V.O.N, nurse. She has not\nhad her public health training. Our firfet visit was to the home of a Jewish mother whose\nbaby is two weeks old. This is the third day the nurse had been in to bath* the baby. It\nwas not the mother's first baby and I could not quite see the necessity for Miss Cameron\ngoing in on this day, even though it was to be a paying visit. Miss Cameron explained\nthat their routine is to return once a week to weigh the baby until it is six weeks old.\nThen 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\nbaby. I did not stay for the whole of this visit. Miss Cameron is a pleasant nurse and\ngave good nursing care, although there were some points in the technique of bathing the\nbaby which I felt might be criticised. No doubt the method she used is the one she\nlearned in hospital. In the afternoon I went with Miss Tanner, nurse with whom I had\ntalked at the Baby Clinic for which no children had arrived. Apparently after I left\nthat day, six monhers did come. Miss Tanner expects to take piiblic health this fall.\nShe is a very bright young nurse and is apparently very popular with her patients. Our\nfirst visit was to a home to see if the mother had returned from hospital. Found that\nshe had been back for two weeks. Seems to be a lack of reporting here. The mother was\nfeeding her baby when we went in. \"Miss Tanner weighed the baby and discussed the baby's\nformula and getting the baby out In the sunshine, also asked about the mother returning\nherself. Second visit was to a six week's old baby. Mother is moving. This mother had\nbeen very timid about handling the baby. Nurse said she would come back before she moved\nto Ontario at the end of this month. Third baby was for the purpose of making the one\nyear visit. Baby was in a crib outside, the mother was very young and perhpas at times\na flighty person. She discussed the general health of the baby and then said \"I won't\nbe back agan, I am dismissing the bab*\". Seemed rather an abrupt word to use in front\nof the mother. Fourth visit was just a stop on the street to see Mrs. MacDonald who was\nsitting on her doorstep. She is a Spychiatric case who has had shock treatment and\n -39-\nis now going in for insulin shock therapy. She has a young baby who apparently is\nalready boarded out. Miss Tanner's attitude to the patient was a very excellent one.\nFifth visit - not at home*\nAfter this went to see the baby clinic on Brunswick Street. The baby clinic is,\noperated in one room by the V.O.N, and next door in a larger room, the city nurses and\nthe doctors come for the immunization clinic. The doctor is supposed to arrive at 3.36* '\nThe nurses arrived shortly after 3 p.m. Already the room was full of mothers and very\nyoung children. The majority of these, oerhaps I should not say the majority, many of\nthese had gone in to the V.O.N, nurse where actually the chief service is a weighing one.\nThe V.O.N. had a St. John Ambulance volunteer who pulls the records. The nurse weighs ji\nthe babty and as the mother is sitting dressing the baby she may talk to the mother if\nthere are not others waiting for weighing. There were some notes on the records, which\nI expect the nurse writes after she has talked with the mothers, applicable to the clinic.\nThe immunization clinic was very poor psychologically. The nurses were attempting to\nsee 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\naround with nothing to do. When the doctor came there was also a stenographer with him\nwho pulled the records if the mother had been there before, if not, made out the card and\nafter the vaccination was given, gave the slip for the return the next dayv It seems to\nae there could be a card made out which could be given to the mother and which would\nobviate the necessity of giving these slips each time. Case of administrative detail\nagain. The doctor sat at a table in front of the room in view of all and gave the\nimmunisations and most of the children howled. One public health nurse, she happened\nnot to have had public health training, but was on the city department, filled syringsj\nher technique was questionable. However, this was the technique permitted by the doctor.\nShe refilled the syringes without taking clean ones. The other public health nurse, she\nwas public health trained, brought the patients up to the doctor and saw thsat the\npatients waiting kept in line, and those who came later did not get in ahead. Some job\nfor a public health nurse I After visiting with Miss Tanner in the morning I returned to\nMiss Shore's office and completed the key form with her. At 4 o'clock, after the baby\nclinic, I returned to discuss students program, etc., with Miss Shore. They seemed to\nbe going in the right direction, but there is not nearly the same understanding of\nstudent programs I think, as there is in Hamilton with Miss Rsss and Miss Sneddon. I\ndiscussed the matter of overlapping with the city and they readily recognized this and\nfelt that perhaps they should drop the six months and one year visit. I said I did not I\nfeel that it was a matter of any one agency dropping anything necessarily. It was a\ncase of clearing and getting together and discussing who was going to do the particular\nthing, I could not see why both the V.O.N, and the city nurse, who apparently only goes\nin at six months for immunization, should go in. If the city so desired, whyc ould they\nnot delegate the responsibility to the V.O.N, nurse for the particular cases which she\nis visiting. In relation to the visit at one year, this is the tine when they pick up\na great many pre-natal cases. However, there is no reason why the city nurse when\nmaking her visit at one year, should not pick these up. As present policy stands, the\ncity nurse does not visit at one year unless they have been delinquent in getting the\nimmunisation done or in sending in the card*\nIn the evening, Dr. Baillie and I went to the Dalhousie clinic to observe the\nT.B. and V.D. clinic which are held there on Friday evening. The clinic has \u00C2\u00ABa very\nnice set-up. Dr. Beckwith was operating the T.B. clinic. Said he would answsr Doctor\nBaillie privately when Dr. Baillie asked why the T.B. clinie was being heid here! Miss\nMyers is In charge of these two clinics. She is a public healtfr nurse who has taken a\nsupervisory course. From the way she talks she has an understanding of better public\nhealth practices than followed in the clinic. However, I do feel there are many areas\nwhere she wight put them into effect, even with Miss Fraser in charge, than she seems\nto be doing. She stated when I asked her, that the public health nurses do see the\npatients. The patients, if they have any trouble come to them. I pointed out that this\nhardly seemed to me to be enough. There is absolutely no social work. Whether or not\nthere is at the hospital, I do not know, but I think not. At any rate there is no\n -40- ^^\nsocial work done to the cases who are coming to the clinic and since most of these cases\nare a poorer group there must be a very great need. Dr. Gosse, who is in charge of the\nV.D. clinic sees all V.D. cases who need to be seen by anyone not giving the treatment.\nIn other words, he does the conferencing. There seems to be some confusion as to who\ndoes 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\nunder Dr. Morton, is the social investigator for V.D. I do not know whether they discuss\nthings to gether or not, but it does seem to be a rather confused program. I do not\nthink it is even worth while te take the time to straighten out these points since many\nof the clinics are going to be moved to the out-patient department of the V.D. as soon\nas it is opened, Miss Myers stated that as far as she understood, only the paediatftic\nclinic would remain. After the clinics move out Dr. Morton hppes to move into the\nDalhousie clinic and the public health clinics will be taken over by the public health\ndepartment. It is hoped that a great many of these confusing points and over lappings\nwill be cleared up. In relation to obtaining a supervisor, for the city department,\napparently the salary offered is $1,800 to 2,200 or $2,400. There will never be anyone\nobtained who will be worth her salt at that price.\n -41-\nfoly 17, ffifo- Saw Miss Lawrence who. is a psychiatric social worker for the Mental\nHygiene clinic. Dr. Jones is the doctor. Talked with her at coffee. She says they\nare very short of staff, but the plan is that the social workers do the follow-up from\nthe clinic. If a school child has been referred in by the nurse, the psychiatric social\nworker visits the school to see the teacher and usually tries to make a home visit. A\nreport is sent by Dr. Jones to the agency and if there is follow-up work to be done in th\nhome, this does not seem to be transferred to the public health nurse. Following my\ntalk with Miss Lawrence, went to see the new Victoria General Hospital. Was shown\nthrough by Miss Millar, Superintendent of nurses. Miss Millar is also president of\nR.N.A. of Nova Scotia, It is a very lovely new hospital.. She has about 67 graduate\nnurses and 135 students. They are very short of staff and it is very evident that\nstudent nurses are being used to staff the hospital. Did notsaee the teaching department\nas it is apparently in the nurse's home.\nSaturday afternoon, went to Peggy's Cove, great piles of rocks and desolation\nbut all the same, rather attractive.\nJuly 19. 194B. - Met with the V.O.N, nurses in the morning and wBnt over the individual\njob analysis forms. Completed my work with the V.O.N, in the afternoon. The remainder\nof the morning saw the nurses with the City Health Department. They all seemed to\nenjoy my visit and contributed some very good ideas. Saw Dr. Grant, Dean of Medicine,\nDalhousie, in the afternoon*\nTuesday. July 20. 1948. - started for Pictou. On the way stopped in Truro where we\ninterviewed Dr. Davis, principal of the Normal School and Miss Reid, the nurse in the\nNormal School. Miss Redd showed us \"Uie Health Education curriculum for the school.\nIt is very factual and I am afraid she tries to give the Normal school students too\nmuch 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\nseems very sincere and is no doubt, doing very good work within her own limits and the\nlimits of the curriculum. The mobile x-ray unit was set up in the adjacent school yaad.\nVisited the nurse and the technicians working on it. Drove throug the Stewiacke valley\nwhich was very beautiful. Arrived in Pictou about 7 p.m. at the Braeside Inn.\n -42-\nNORTHUMBERLAND HEALTH UNIT\nOH 5f c?48 \"n!6^ *\u00C2\u00B0 ihQ \u00C2\u00B0ffice \u00C2\u00B0f the Northumberland Health Unit. Had a meeting\nwith Dr. Sims, Dr. Lavers, Miss McCann, who had returned from her holidays for my visit,\nand 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\nfrom them all how they did their work. The group present consisted of -\n1, Miss McCann, who is to be the supervisor and is acting now in the capacity of senior\nnurse; she, however, carries a very heavy case load. She has West Pictou and it has a\npopulation of. 20,000, she also has North Colchester. Her towns are Pictou, Westville\nand TStamagouch. She has 67 schools in West Pictou and 29 in North Colchester.\n2. Miss Gray, who has East Pictou, the towns consisting of Stellarton, New Glasgow and\nTrenton. She has 70 rural schools and three or four town schools. Miss Gray is a\nveteran of the first world war and has not had a public health course. Her total population is 25,000,\n3. Miss Munro, who has West Cumberland, population of 20,000.\nParsboro. She has 28 schools.\nHer towns are Amherst,\n4. Miss McGarry who has only been on since March and is getting some experience prior\nto taking her course at Toronto this fall. She does not have any assigned district\nbut works with Miss McCann.\nThe chief problem centres around the fact that they each have such an extended\nterritory and the follow-up visiting is very difficult, if not impossible. It does not\nseem that the winter holds them up too much because they can then concentrate on their\ntown work if the roads are impassable. In addition to these nurses Pictou has two V.O.N,\nnurses. Glasgow has two V.O.N, nurses, Amherst has two V.O.N, nurses and Canso has one\nV.O.N. There is also a school nurse employed by the towns of New Glasgow, Amherst and\nTruro. However, Truro is in South Colchester and is not in the Northumberland Health\nUnit. Miss Munro says that Parsboro has a nurse employed on a part-time basis to look\nat the heads, communicable diseases, etc. It is much harder for her than if there were\nno nurse. As a rule the public health nurse works with the local school nurse and the\nV.O.N, in the immunization program but not to any other extent. Tuberculosis seems to th\nmajor problem. The nurses did not seem agreed as to whether it or the school work took\nthe major part of their time. There is a great shortage of sanatorium beds. Sometimes\nthe waiting period is three months, in which time the nurse supervises the home and\nvisits as frequently as is possible. Apart from the home supervision of the case, the\nnurse is responsible for the patch test of all the family contacts. She must return in\nfour or five days after giving the patch test to read it. She does not encourage them\nto go to the family doctor to have it read as it is very difficult usually, for them to\nget to the doctor. However, I think that some thought could be given to this in some\ncases. If there are open cases they are requested to get sputum tests about three times j\na year. In relation to x-ray appointments, the family doctor informs the patient of\nthe next x-ray day or in some areas, where the clinic is set up, may be told by the nurs\nAll contacts and indigents come to the clinic free of charge. The others go to the\nhospital for their follow-up x-ray and they are expected to pay for this.\nChild Welfare - pre-natal, - there is no organized program. They do it incidentally\nwith their other program. No records are kept of pre-natals. Infants and pres-echool\nbirth lists are sent from the hospitals at the end of each month, except to Miss Gray's d|\ndistrict, and she goes to the hospital and copies the list. No doubt, however, she could|\narrange to have it sent, but prefers to do it this way. From this list the nurse makes\nout the school card. This could be done by a stenographer, but is not. The card is\nfiled in the office. When the baby is six months old a letter is sent to the mother from|\nDr. Sims stating it is now time for immunization. (See copy of letter in folder.)\nBetween the ninth and the twelfth month the nurse visits the home. This is called the 1:\n -43-\npre-school visit. She then marks up the card recording the immunizations. This is the\nonly record for the pre-school and infant program. The Health Dept. nurses do not hold\nany baby clinics, the following are held by the V.O.N., - New Glasgow, every Friday with\nan immunization clinic once a month; Pictou, two times a month, with an immunization\nelinic in the fall; Amherst, every week, an immunization clinic in the fall and in the\nspring. There is no doctor present at any of these clinics. The routine seems to be\nthat one of the nurses will weigh and measure and the other may conference. They do not\nseem to use volunteers. In relation to booster doses for immunization, three to six\nmonths after the third dose, a booster is given. Some doctors will give a return date\nfor this. During the visit the nurse tells the mother about it. The second booster\ndose is given the first school year or before. No record is kept for incidental health\nproblems.\nSchool - The V.O.N, nurse carries on the school work at Pictou and Canso. The nurses\ntry to visit the schools once a year but this is not always possible. For example, Miss\nMcCann and Miss Munro have not completely covered their district in the past two years,\nfhey try first to find the area with the greatest need. They have an opportunity to do\nthis because at the beginning of each school year they make a quick visit to each school,\nreally in regard to immunization. Then they choose a centre for the fall immunization\nclinics. From then on the work is left with the teacher to organize. She arranges with\nthe doctor and arranges the day. When it is all ready the nurse will come and help. The\nteacher also arranges the publicity and in each school the teacher gets the consent slip\nsigned. For example, last year in Tatamagouch there was one clinic which took in the\n29 school^, of North Colchester. Apparently the doctor is very enthusiastic and he took\na major part in the arrangements. The nurses also do patch testing in the high schools\nin gr\u00C2\u00ABufe9 and the negatives in grade 11, and all new pupils. This is done at the\nbeginning of each school year. If they are positive an x-ray is arranged.\nThe doctors do not do any work in the schools. The following is typical of\n\u00E2\u0096\u00A0Idle yearly visit of the nurse to the school. She will probably spend one-half day there.\nThis would be the routine of the visit.\n1. Weigh and measure the children. She takes the scales with her,\n2. Test the eyes with Snellen chart.\n3. Examine head, general condition, teeth, hearing, etc,\n4. Complete the record which stays in the school.\n5. Conference with the teachers,\n6. Copy the names with defects on the sheet.\n7. Make out defects list. (This is done in triplicate, one goes to the parents, one to\nthe family doctor and one is kept by the nurse, this latter is taken to the office\nand filed.)\n8. Inspects sanitary facilities and if necessary, makes notes to report to the sanitary\ninspector.\n9. Conference with teacher. These points are not necessarily in the order completed.\nAny of the major defects such as eyes, orthopaedic, malnutrition, etc., the\nnurse attempts to follow up with a home visit. Card is made out for all new children\nby the nurse. Any information which she cannot get on that visit will be obtained from\nthe parents by the teacher and the card will be completed. Sometimes the teacher helps\nwith the records, weighing, etc. The nurses try to get the teachers to start school\nlunch programs and have been quite successful in some areas, in others, not. The nurses\nfeel that a great deal of factual information on health is taught to the children and\nnot nearly enough from the practical aspect.\nCommunicable Disease Control - The M.O.H. for the area is responsible. The teacher will\ncall him if she has any suspicions. Some times the nurse may be called. The teacher is\nresponsible for contacts.\n -44-\ngenereal Disease - This Division was a specialized service until about two years ago when\nIt It3 JSw^ h! fneralized Program. Each card has a case on file in the office.\nEvery month the nurse takes each card, goes over them with the private doctor. He gives\nher 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\nfurther treatment.\nTuberculosis Control - In relation to the T.B. work there seems to be a great deal of\nrecording. (Copies of records kept in separate folder). In relation to the daily and\nweekly reports which the nurse makes, there seems to be a lot of duplication. Miss\nMcCann says that it takes nearly all of Saturday morning to do the weekly report.\nTuberculosis record - clinic form I contains the data on the patient. The nurse copies\ninformation from this into the black loose-leaf book which she carries. This is the only\nplace in which home visits are recorded.\nAt the meeting in the morning gave the nurses the individual Job-Analysis form\nto complete and asked Miss McCann to send this in in a couple of weeks. In the afternoon\nvisited the V.O.N. There are two nurses, Miss McKeracher, who is away on holidays and\nMiss Shaw who has been with the Order for a year and a ahalf. She has not yet taken the\npublic health course. The V.O.N, has Pictou town. They have two clinics each of which\nis held once a month. At one clinic the attendance is from 15 to 15, at the other 25 to\n30. There is no doctor in attendance. They take babies from two months to one year.\nOne nurse weighs and measures and the other conferences with the mothers. Sometimes\nthere is a volunteer. This seem generally to be in the summer time when one nurse if off,\nIn the winter time the two nurses work by themselves. In the fall an immunization clinic\nis held and the health department nurse assists. The school work is just regular routine.\nNo report is sent to the Health Officer. Asked Miss Shaw if she would send me through\nMiss McCann, a copy of the 1947 report. Had dinner at Pictou Lodge with Dr. Lavers and It\nMiss McCann, after which we went to the home of Dr, Sims, Had a very nice evening. They\ntold us stories of their experiences in Nova Scotia, Many of them were very amusing.\nOne which seemed to give them a great deal of amusement was a letter which was received\nfrom a mother following patch testing of the family - it is unusual for the nurse to\nask that the report be sent in by letter, but because of transportation difficulties it\nwas done in this case. This was the letter - \"Dear Friend, This is to tell you about\nthe patch test which you gave us. There is nothing on any of us except Rupert, who was\nred at both ends. That is all. No lumps, no bumps.\"\nJuly 22. 1948. 9 a.m. - Started on a two day trip to Antigonish and Guysboro County with\nDr. Sims and Miss McCann. We arVived at Aberdeen Hospital shortly after 10 a.m.\nDr. Baillie and Dr. Sims saw the M.O.H. Miss McCann and I talked with Miss Mary Ross\nwho is the Superintendent of nurses there. Miss Ross trained at the Aberdeen Hospital\nand has had no further qualifications for the position she now holds. Miss Rhoda\nMacDonald has been the Director of Nursing but has recently resigned. Miss Saunders who\nhas been her assistant has recently been appointed. She also was trained at Aberdeen and\nhas had no further qualification. I should think that the nursing situation looks\nrather grim. Miss Ross lacks push and does not seem to have very much comprehension abou\nnursing education, neither has Miss Saunders. They have a school of nursing and have\naround 60 students. Miss Ross says they are taking in fewer this term. The Board has\nan idea that students are costing them too much and therefore, they are reducing the\nnumber. They will soon learn that the students have saved them a lot of money and that P\nthe graduate nurses that they will have to substitute will cost them a lot more. Plans\nare under way for a new hospital. Nurses are certainly needed in key positions in\nNova Scotia.\nFrom Aberdeen Hospital we drove through Stellarton and saw what is known as\nRed Row there. The thomes of tha miners. From Stellarton we drove through very nice\n -45-\nITfZ T\u00C2\u00B1JEtigl?t+ WueVtJe. had diDner at Betha^ House> *** is the Mother House\n\u00C2\u00A3+v^ r^t r%f 2!: MaTtha*s- M\u00C2\u00B0ther Ignacious is there, but did not dine with us.\nw LS7, h Extension Department of St. Xavier joined us for dinner and kept us\nfascinated with his description of his philosophy of living for Canada and Canadians\nand toe story-ot the cooperative movement. After a delicious dinner we adjourned and\ntalked again with Mother Ignacious. We then went down to the University and saw Dr.\nCodyjs set-up. He showed us some maps with pins showing all the co-operatives, the\ncredit unions, the wholesale houses, etc. From there we went to St. Martha's Hospital.\nMiss McCann and I saw Sister Mary Calvary very briefly. It was not possible to get a\nsyllabus of their nursing course. Sister said that it was in print now and she would\nbe glad to send it to me. They have some sort of an affiliation with the University.\nSister said it was a weak affiliation. The University grants a degree; I question as\nto whether or not that degree would be acceptable in other Universities in Canada, but\nSister thought that it is a University degree and that as the University is recognized\nthat it also would be recognized, even though apparently, two years credit is allowed\nfor the three years of nursing training. From the hospital we drove to Grant's Hotel\nin Guysboro. Guysboro/ is a very small community but has a very beautiful situation.\nWe went out for a walk in the evening and later on met Miss Morrison who is the nurse\nfor Guysboro County. With her we want away out into the country to see a scarlet fever\ncase. There is one doctor in Guysboro and as he was away on his holidays, Miss Morrison\nseems to be called in a great deal. The doctor puts a lot of responsibility on feer.\nThere is a Red Cross Outpost Hospital but no patient can be admitted without doctor's\norders and when the doctor is away, Miss Morrison has to see the patient before they\nwill admit.\nJuly 23. 1948.- Breakfast early so that some fishing could be taken in before our trip\nto Guysboro County. No luck at fishing. We drove on from Guysboro to Canso, taking\nthe route along the coast. Canso is a very bleak and barren fishing community.\nCo-operatives are active/ there and this has, to some extent, improved the lot of the\npeople. Apparently you belong to one of three social classes according to where you\nlive. You may live \"up on the hill\" which is a community known as Hazelhill; you may\nlive \"down over the hill\" in Canso or you may live \"on the Tittle\". The Tittle being\ntheir way of referring to the area along the strip of water known as the \"Tickle\". The\nrocks crop out everywhere' and make it very difficult to raise any crops whatever. There\nwere a few gardens but these were rather poor. Miss Morrison who accompanied us on\nthis trip took me into a home. There was a month old baby. The V.O.N, nurse had been\nin attendance but for some reason when the baby was ill Dr. Stanton, who is the doctor\nin this community, called in Miss Morrison. This was her second visit and apparently\nthe baby was better. The home was very poor and very dirty. There were five children,\nall the children are rather small for their age. This is characteristic of this whole\nfishing village coast community. Miss Morrison says that about $0% of the homes in these\ncommunities were like the one which she took me to.\nFollowing a tour around the town, we went to the Red Cross Outpost Hospital\nwhere it had been arranged that we should have lunch. This hospital was opened the\n26th of May. It has ten beds. At the time it had four patients, two of them being\nmothers and their two babies. The other two patients, a man with virus pneumonia and\na month old baby who had been admitted with diarrhoea; the baby was better. Dr. Stanton\ntalked 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\nhave been to him for pre-natal care. A large percentage of the children in the schools ?\nwhich he visits are immunized. He has been there for ei^it years and was about ready to I\nleave when the Red Cross Hospital was established. This has given him a new interest\nand has made his facilities so much better. There is a V.O.N, nurse in Canso; she is\nnot trained in pifclic health. From what I could gather from Miss Morrison she does some\nof the schools and is supposed to be responsible for bed-side care and the infant\nwelfare. However, there did seem to be some overlapping. I do not know the reason for\nthis. Perhaps the doctor does not work so well with the V.O.N, nurse.\nAd\n -46-\n^ * GT^\u00C2\u00B0 C2?ntar\u00E2\u0080\u009Eia divided ^ two municipalities. It has a population of\nsomewhat over 16,000. Miss Morrison has 90 schools with a population of 3,000 pupils. In\n(ganso there are five sisters who do what is described as social work, it seems to be to\ngive material relief and work with unmarried mothers placing their children. There are no\nother nurses in Guysboro County. From Canso we went to Dover which is a fishing community\nand is bleak and barren as Canso. Then from Dover to Whitehead, Torbay, Larr^River where we\nconsidered whether or not we should come back to Guysboro. However, Dr. Sims seemed very\nanxious to show us the country so we continued on the trip going through Goldboro, Isaacs\nHarbour and Country Harbour. It was all very beautiful then up through the country through\nwhat is known as the Barrens to Melrose and down to Sherbrooke where we had dinner.\nSherbrooke is on the St. Mary's River. After dinner we went fishing. No luck again. We\ndrove back to Antigonish to the Royal George Hotel, through what appeared to be very beauti\u00C2\u00A9\nful country, especially along Lake Lochabar. However, it was after dark and we could not\nsee it. Through the kindness of Dr. Sims and Miss McCann in taking us on this trip we\ncertainly gained an impression of the vastness of their problem or rather the problem of the\nrural nurse in such a county, such as we could not have obtained in any other way. Dr. Sims\nfeels that there should be at least four nurses for Guysboro alone and he is planning to\nbuild up his program to have at least one nurse for every four to five thousand people.\nThis is a long term project and it will be some time before it will be achieved. Miss\nMcCann and I had lengthy discussions about the nursing situation in Nova Scotia. She feels\nvery pessimistic about it, especially in relation to the training schools. She feels that\nsome stimulus is needed and that it will be quit^ a long time before we will be able to\nget them on a truly educational basis. She has not been appointed supervisor although she\nhas had a great deal of experience. She taught school for nine years, took her nurses\ntraining, then she took teaching and supervision at McGill, following which she had experience in instructing work and as assistant superintendent and superintendent of hospitals.\nThen she took her public health and has been more or less acting as senior nurse in the\nNorthumberland Health Unit. She, \"however, has a very large area of her own. When new\nnurses are taken on, she is the one who is responsible for planning their work.. For some\nreason her appointment as supervisor has not gowe through. Spoke- to Dr. Sims about this\non Saturday morning as we were leaving. Apparently he feels that she should go away to\nColumbia for a summer term just so that he will be able to say to the other nurses that she\nhas had this extra qualification. I said that I felt that she had the extra qualifications\nnow and it would be too bad to wait for another year before making her appointment official\nand allowing her to obtain the extra salary which goes with it.\nJuly 24. 1948 - Left Antigonish about U a.m. for Baedec. Crossed the Ferry from Mulgrave\nto Port Hawkesbury. It was raining so the trip was not so enjoyable. Arrived in Baedec\nabout 2.30 p.m. Met Miss MacDonald at the home of Dr. MafiMillan. Reservations had been\nmade for us at Normaway at Frizzelton which is up the Margaree Valley. We went there and\nhad very fine accommodation. Dr. Baillie got in some fishing Saturday evening and then\nagain early Sunday morning. About 11 a.m. on July 25th we left to go aground the Cabot\nTrail. It was rather dull at first but when we got out jio the coast it cleared. The roads\nwere not too bad until we started coming donw from Ingonish then they were rather rough\nand there was a lot of construction work. We arrived in Sydney about 11 p.m. and got to\nour rooms in the Isle Royale Hotel.\n -47- IP\nCAPE BRETON HEALTH UNIT\nJ^f *l ^ \"/et \u00C2\u00A3f **\" morning ^th Dr. MacDonald and Miss Hazel MacDonald. Their\n2*4* n! ^ \u00C2\u00AB Xf ^ h\u00C2\u00B0?S8 which was Purchased about three years ago for the Health\nUnit. Dr, McCurdy is the doctor in charge of the Tuberculosis work in this area. After\nthe general meeting I met with Miss MacDonald and planned the program for the week.\nThe rest of the day was spent in getting information for the key forms. Cape Breton\nhas a population of about 150,000. The county of Cape Breton has 110,000. In this\narea there are five incorporated towns within the radius of fifteen miles of Sydney.\nThere has been a move to make a metropolitan unit of Sydney and the area. This would\nhave four districts and four full time medical officers of health. It has not gone into\neffect because of personnel needs. The nurses have about 350 rural schools. They are\nnot responsible for the following town schools which have their own school nurses.\nSydney - 1 school nurse;\nGlace Bay - 2 school nurses;\nNew Waterford - 1 school nurese.\nThe following hospitals have Schools of Nursing - City Hospital, Sydney. St. Joseph's\nHospital, Glace Bay. New Waterford General. Glace Bay General. Hamilton Memorial,\nSydney.\nMet with the nurses of Cape Breton County in the Health Unit office. Explained\nthe Survey and went over Job Analysis forms. They will all complete these and send them\nin. Two of them will also do/\u00C2\u00A3 the School Nursing questionnaire. Then followed a\ndiscussion of their work.\nPre-Natal Programme - The nurses feel that they are not doing enough. The doctors do\nnot refer cases. They are all convinced that the public health nurse has a part to\nplay in pre-natal health supervision. They realize with the present set-up they cannot\ndo very much more. They also realize that some program is necessary to educate the\ndoctors to an understanding that the nurse has to play. With regard to the post-natal\nprogram, the nurses felt that the doctors do not do proper post-natal examinations.\nVenereal Disease - This is a great problem and they do not know how to approach it.\nUntil quite recently it was carried by a specialized worker and now it is to be included\nin the general program. They feel that more education on the part of the public and\na more understanding attitude to the subject is necessary. They, themselves, feal that\nthey need much more preparation and practical experience in venereal disease control\nin their post-graduate work in public health nursing. They state that they have hardly\nany and are just given the literature. Another difficulty is that the clinic in Sydney\nis a very dark room in the city hall. There is a movement to have it transferred to\nthe Health Dept. building. This will make it very much more suitable and easier to\nhandle. There is no social service, it is\"purely a treatment clinic.\nInfant and Pre-School Program - They feel the need for more Well-baby conferences and\nfor better follow-up in the homes.\nTuberculosis - This seems to be their major program. They feel that there is a much\nbetter understanding on the part of the public. The problem of beds for open cases\nis not a great one and they have very few opeh cases in the homes. They feel that the \u00E2\u0096\u00A0\nmass surveys have helped a great deal. In my visits following I noted a great change\nin the attitude of the people toward tuberculosis. They were all very anxious to have Pj\nx-rays.\nSchool program - Getting the defects corrected is the biggest problem because of the\nlack of facilities. There is a great lack of dental care and also the cost prevents\nmany from obtaining such care. Transportation costs to the centres are very great and\ndeter many from receiving the attention needed, I asked them if they felt they were\nlosing out because of the lack of physical examinations by the doctors in the schools. |\n -48-\nThey said. no. Cardiac is about the only thing which the nurse would not discover\nand there are so few of these that it would not be worth while to have the doctor\nexamine all the children. We discussed the background needed by the teachers. They\nfelt that they needed something more practical. They stated that many of them do a very\nfine job. In nutrition, we-discussed the use of consultants. We discussed the mental\nhealth program. Nurses are all agreed that they have a major part to play and when\nbehaviour clinics are established they should prepare a history on the homes and that\nthey should also do the follow-up.\nOrthopaedic program - The Red Cross had a clinic during the war but they have stopped\nit now. At the present time the Rotary has a clinic and has an Orthopaedic doctor\ncome. The Health Department nurses assist at these clinics. Only two are held each\nyear. Cases are referred to the nurses for follow-up. Arrangements may be made to\ngo back and forth to Halifax. All these are things which the nurse has to do and are ve,\nvery time consuming. C.N.I.B. clinics are held and the Health Dept. nurses attend\nthese the Saturday that the clinic is in session. They are held at three centres.\nThe following is a division of\neach district -\nJape Breton Unit and the number of nurses in\nCape Breton County - 8 nurses, 1 supervisor;\n110,000 population\nInverness County - Miss MacDougall and part time of Miss Martell and Miss Lytle,\n21,000 population.\nVictoria County - Part time of Miss lytle, stationed at Baedec. Miss Jessom at\nIngonish, 6,000 population\nRichmond County - Miss Martell. 11,000 population\nIn the afternoon went to New Waterford to be with Miss Setchell. New\nWaterford has a population of about 10,000. A school population of some 2,000. There\nis however, a school nurse. New Waterford is only a part of Miss Setchell's district.\nShe has a very nice office in the Town Hall. She keeps all her own records and has no\nclerical assistance. Saw Miss Setchell's records, she has a family folder for nearly\nall her T.B. cases. There are very few other records than the T.B. Inside the family\nfolder there are the green history sheets and also a social data sheet which is\nyellow. There has not been a clear distinction between the information which is to\nbe put on the social data sheet and the information on the individual sheet. There is\nvery little real social information. The nurse copies the T.B. x-ray report onto the\nrecord. There seems to be a lot of clerical work for her. There are a great many\nsocial problems in connection with the tuberculosis cases in New Waterford. Miss\nMacDonald 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,\nwhose husband was dead and who has five children, the last one born illegitamately.\nBecause of that her Mother's Allowance was cut off. Miss Setchell has been spending a\ngreat deal of time conferring with welfare offices, etc., in an endeavour to have this '\nallowance re-established. A second case, Mrs, Hincks whose husband has just been let\nout of jail, where he was detained for a month because of treating his wife abusively.\nThere are four or five children in this home and very little money. Here too, there ;\nare a great many social problems. Miss Setchell has many such cases. One wonders how\nmuch nursing there is in dealing with these cases. Is it not more social work? Do we I\nneed to consider a different type of training altogether for this community worker?\nAfter mkking the T.B. visits we called at the New Waterford Hospital for the ;\nimmunization trays. I talked briefly with the superintendent, Mrs. McLaughlin. The\nhospital has 70 beds, there are 30 students, 5 supervisors, 4 general duty staff nurses/\nThere are mo practical nurses. Ward maids are used for the housekeeping duties on the\nwards, however. Miss Setchell was having her weekly immunization clinic. This was V\n -49-\nheld in the Legion Hall. The doctors, of whom there are five in New Waterford, take\nturn about in coming to it. Usually there is an attendance of 20 to 30. They give\nvaccination for smallpox and combined whooping cough and diphtheria. Scarlet fever\ntoxin 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\non the table, forceps, syringes and needles in a tray. Two students from the hospital\ncame to assist just before the doctor arrived. No notice is given to the mothers about\nwhen to return. They all seem to know. If they do not turn u$ at the clinic when they\nare supposed to, a penny postcard is sent. Last year there were only eleven who did\nnot finish the complete immunization. All the cards are looked after by the nurse before\nthe doctor comes. This seems to be quite an efficient way of doing it. The routine\nfor immunization is * the student swabs the arm, nurse holds the arm while the doctor\ngives the immunization. The second student changes the needles and fills the syringe.\nThe Baby clinic is held in this same room twice a month. A volunteer worker assists\nand 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\nand cod liver oil to the diet. If the mother were going to go to the doctor she probab- .\u00C2\u00AB\nly would not change the formula. She tries to follow up as many cases as possible into\nthe homes.\nNew Waterford is a mining centre, dirty and smokey. Miss Setchell seems to\nbe a very efficient nurse. She took her course last year at McGill. Previous to that\nshe was In the Navy and has had ten years of operating room experience.\nJuly 28. 1948 - Met with the V.O.N, nurses. Miss D. Armstrong in charge. Explained the\n.survey and left Job Analysis forms which Miss Armstrong will send in later. Completed\nthe information forms. Did not arrange to do any visiting with these nurses. Miss\nArmstrong is the only one who has had public health training.\nWent at 11 a.m. to see Miss McPhee, the Metropolitan Life Insurance nurse in\nGlace Bay, Her program seems to be pretty much the same as the V.O.N, except I would\njudge the instructional work is more limited. She does not have any clinic. Hiss\nMcPhee has had public health nursing. She is the only Metropolitan Life Nurse outside\nof Quebec. She has been eight years in Glace Bay and previous to that, she was three\nyears in Fort William*\nIn the afternoon went with Miss Buffett to her rural area. We visited the area*\naroundManidieu and Louisberg, The majority of the visits were T.B. cases. The first\none a young girl of eighteen who suspected tuberculosis and was supposed to be on rest.\nTalked to her at the gate*\nSecond case - Mrs, O'Neill who has had tuberculosis for the last five years and is now\nleading a more normal life. Her children took over the household duties and managed\nvery efficiently all during the time she was ill*\n3* A Mrs* Bate who had had tuberculosis for about three years. She has three children.\nHer sister looks after the children.\nI was very surprised to find, in most of these homes, electric light and\ntelephones. Their standards of furnishing however, are very low. Some of the houses\nwere very clean but the floors might be in very poor condition and there was very little-\nfurniture. They seemed to be content with just essentials.\n4* To a case who had recently been discharged from the Sanatorium, Three weeks before\nhe was discharged his wife was taken in. His mother looks after three small children.\n5* An elderly woman who was arthritic. Her daughter who was formerly t^erculosis\nand now there is a possibility of T.B. peritonitis. Is also deaf. Second daughter\nteaches school in a nearby area. She has forty-nine pupils* . JJ\n -50-\nH A!?^eL^ A*t a1*? 3^ldren\u00C2\u00BB y ~ a very clean home. Nurse called because\nof a child who had tod stra/bismus. We found the mother had very bad varicose veins and ,\nUhTSSS ST;\u00C2\u00AB S!^ \"J? \"\"^ ears> *** of whom hid very large tonsils.\n? 4\u00E2\u0084\u00A2+ L^L^ ? wawera there. He had apparently joined a Blud Cross group and\nhas just been waiting for the slip before having these conditions attended to. The mother\nhowever, was not planning to have anything done about her veins.\n-,.. /^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\nold Fort and called for a few moments at the museum. I was disappointed that I could\nnot see the surrounding country as it was foggy all the time we were there. The little\nharbours and fishing hamlets looked very attractive.\nIn discussing with Miss MacDonald the solution to some of our personnel prblems\nshe feels that the taking on of the untrained public health nurse is the only solution*\nWould like to take oh more of them with the understanding that they would take public\nhealth at the end of a year at least. She did not seem to feel, at first, that a course\nshould be started at Dalhousie. She felt that when there are good course established\nalready that the nurses should go to one of the existing universities. I pointed out to\nher however, that when the girl gets away from the Maritimes she is frequently offered a\njob at a much better salary and does not return. Also that an attempt to increase the\nnumber of \u00E2\u0096\u00A0ahamla students attending to fill the needs in other provinces that the\nexisting facilities would not be enough. I think she agreed that a course might be\nstarted at Dalhousie even under existing conditions. That we cannot await until field\nwork is ideal. The great problem here is definitely shortage. They are all set to\nexpand and will do so as soon as they can get more personnel.\nJuly 29. 1948. - Left Sydney about noon to call at the Gaelic Mod at St. Anne on the way\nto Baedec. Dr. Baillie drove down with Dr. MacDonald just ahead of me. It was a very\nbeautiful drive down the lake. When we got to the Rock ferry theirs was the last ear to\ngo on and I had to wait for the next one. Froa the other side we drove up to St. Anne,\na short but attractive piece of country. The Gaelic Mod is just like one big picnic.\nWhen we arrived some bagpipes were being played and there was a competition of singing,\nScots songs without any accompaniment. There followed some Highland dancing by groups of\ngirls. Lord and Lady MacDonald along with Premier Angus MacDonald and other notables were\non the platform. It was a burning hot day and everybody was feeling the heat somewhat.\nThe Mod was held at the Gaelic College and the bleachers were out on the open on a slope\nof ground facing down to the lake with the hills on the other side. After about an hour\nand a half there we drove on to Baedec. Dr. Baillie stayed at the Inverary, but as the\nwhole place was very crowded I could not get a room there and had arranged to stay with\nMiss lytle in her apartment. We went fishing with Dr. and Mrs. MacMillan and Miss Lytle\nin the evening and after that stopped off at the MacMillan*s. We did not leave there until,\nafter 2 a.m. It was a gay party. Mrs. MacMillan is rather deaf and to have visitors like\nthis was quite an event or so she said. She was most anxious to make a party of it.\nMiss Lytle also had some other people in her apartment and she stayed at Mrs. MacMillan's.\nThe next day went with Miss lytle on a visit. It is a pleasure to find that she\nis doing a great deal of child welfare and pre-natal work, after seeing most of the other\nnurses in Nova Scotia concentrating on tuberculosis. Apparently her tuberculosis problem\nis not so great. Hers is also a unique situation. Dr. MacMillan is the medical health\nofficer. He is a general practitioner and is somewhat of the old family type of doctor. <\nThere is no hsopital in the area although before very long there will be a Red Cross\nOutpost. Consequently there are many home confinements and Miss lytle assists with them\nall. She is thus able to give some pre-natal home supervision and able to follow up the\nsupervision through her clinic and her home visits. She has some 85 schools, her territory\nhas been increased within the last year or so. Interestingly enough she is not doing as\nmuch pre-natal work in her new area. This seems to have something to do with the doctor\nand the particular situation which has grown up in and around Baedec. Miss Lytle has\nk\n -5*\u00C2\u00BB\na very nice office in one of the town buildings. The hallway of the building serves as\na waiting^room when she has a clinic every third Friday. She is also in the office\nevery Friday afternoon and the mothers know this. On the Friday that I was there already\nby three o\u00C2\u00ABclock more than half a dozen mothers had arrived. She takes them into her\nroom individually and sits down on a comfortable couch and talks with the mother. If\nS?7 a\"\nuTsea could have a set-up like this, much greater respect would be paid to\nthe public health nurse and her work would be much more effective. Although I know that\nthis particular method of doing public health nursing may be very much open to criticism\nin that the public health nurse is almost serving as an assistant to the doctor, never\nthe less, Miss Lytle has established a relationship with her patients which I had not\nseen elsewhere. She apparently has developed this set-up very much on her own. She\ndid not have a telephone of her own so one day she went out and said to three girls who\nwere sitting on the bench - \"How about putting on a dance to-morrow night and paying for\na telephone for my office\". A dance was put on and the telephone was secured and the\nmonthly fee paid for several months until Council could take it over.\nThe first visit made with Miss Lytle was an infant welfare visit. It so\nhappened that the mother had come into town. Miss Lytle knew this before she left and\nDr. McMillan, knowing that she was going to be home asked her to remove some sutures in\na little girl's foot which he had put in previously. I questioned this and wondered if\nthe mother could not have taken the little girl to town. Miss Lytle said, Undoubtedly\nshe could but as she was coming along and Dr. MacMillan had asked her, she was willing\nto do it. However, apparently Dr. MacMillan does not save himself and would be just as\nlikely to make a call as to ask the mother to bring the child to hospital. This was a\nvery poor dirty home. A six weeks old baby was in a basket in the kitchen, it had never\nbeen put out in the sunshine*\nThe next home was to visit a six weeks old baby, the first of a young mother who was\ndoing very well and is most anxious to have the nurse come and assist her with the baby.\nShe had the baby outside in a crib covered with a screen.\nWe made a third visit where there were young twins. Both babies had sore buttocks and\nMiss L\u00C2\u00A3tle gave very good instruction to the mother. This mother also did not have the\nbabies outside. It seems she has twins only a few months old and another set of twins\nonly a year older in addition to a litte four year old girl and she has her hands full.\nIn the ten years that Miss lytle has been in this area there have been over\n500 home confinements. When the Red Cross Outpost Hospital is established they expect\nthat most of the mothers will come into hospital and it is Miss Lytle's intention to\neducate them to this. It will however, be rather difficult for Dr. MacMillan to use the\nhospital. He has been so used to going on his own. We took Dr. and Mrs. MacMillan and\nMiss Lytle to lunch at the Inverary. Later in the afternoon we drove to Noraafay where\nwe were to stay the night and then go on to Inverness on Saturday. Dr. Baillie's mother\nand fattier were in the district and in the evening they went fishing. In the morning yvJI\nat 5.30 we went fishing again. I got up and went a^ong with them and then drove on to\nMarguerite Harbour. It was very beautiful in the sunrise. Took a long walk on the\nbluffs and on one bluff came to an old oemetary where most of the departed McLean's of\nthe area lie buried. I returned back up the valley,taking some photographs on the way\nand also had a walk up the hillside along an old logging road. After breakfast we set\nout for Inverness where we were to see Miss McDougall the public health nurse. We found\nher office in a building on the main street. First of all, I should say that we had\nbeen warned that we would find Inverness a very dreary place and it was. It is a coal\nmining town and apparently for some time the coal mines have not been operating and\nare just getting back into production. It is dreary and unprogressive looking and a\nmost unstimulating place in which to live. To get into Miss MacDougall's office there\nwas a high step to get into a very small room. There is just no place for privacy and\nit certainly would not be an inviting place for anyone to come to conference with the\nnurse. There is not even a sign on the door.\nMiss MacDougall's area covers most of Inverness county from fW**\u00C2\u00BBV~ Bay\ndown to Judique. She does not have Port Hawkesbury. Population is some 18,000.\n -52-\nand area alone have 7,000. This was most surprising as it does not look to\nbe such a large place. Inverness has a population of around 25,00*. The hospital\nfacilities areas follows - 2 hospitals in Inverness, each with about 25 to 30 beds.\n1 in Chetticairtpand 1 in Port Hawkesbury. There are two doctors in Inverness, three in\nChetticantpand two in Port Hawkesbury.\nMiss McDougall did not seem to be very familiar with the staffing and work in\nthe hospitals. I do not think she has much contact with them or has endeavored to\ndevelop 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\nstill some who were confined at home but apparently the nurse did not call. She stated\nthe doctors are not interested in pre-natal work. There is a check-off system here\nalso. I do not think that she has gone to very great trouble to have the doctors refer\nthe pre-natal cases to her. She has no clinics for babies and no time in which the\nmothers can come to her office, and as I stated before, it is not a very inviting place\nto come to. She does not get any lists from the hospitals or is not notified of births.\nShe says that very few mothers are breast feeding their babies. She tries to do all\nthe education she can in the home visit.\nthe fall.\nThere are two tuberculosis clinics held in this area, in the spring and in\nHas only about ten cases waiting for hospital.\nIn relation to venereal disease she says there are plenty of cases which she\nhas not on her file.\nThere is no welfare representative in Inverness, The nearest is Sydney.\nShe has 77 schools and a population of around 3,000. French is the language used in\nmost of the schools around Chetticant. She said it would be a definite advantage if\nshe were bilingual. There are only three dentists in Inverness county, one in Inverness\none in Chetticant and one in Port Hawkedsbury. She has an immunization clinic once a\nyear in Inverness, about fifty attend. Miss MacDougall does the immunizing herself in\nthis situation. Permission has been given for her to do this. The M.O.H. for the\nrural area of Inverness is a Dr. McNeill, stationed at Ma&m* He is over 80 and his\ntechnique in Immunization is very poor. Miss MacDougall was going on her holidays\nnext day and after that expects to be transferred to Halifax County. She has been in\nInverness for four years and one would definitely feel that was long enough for any\nnurse to be in that situation. Miss MacDonald was very concerned about Miss MacDougall\u00C2\u00AB\nShe thought that either there was some physical condition or that there was something\nbothering her in her home situation. I felt that she was rather slow in her responses\nand did not have as good a knowledge of the area as she should have. Dr. Baillie,\nhowever, did not agree, and thought it was very difficult for her to answer when two\nstrengers came in and started questioning. He felt that she did know the situation\nand 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\nmany things to do and she can only skim the surface* Perhaps they need some guidance\nin the manner in which most work can be done in the easiest way. For instance, I do\nthink that Miss Lytle \u00C2\u00BBs system of being in the office and the mother coming in is very\ngood. For one thing, the people are coming to the nurse and not the nurse going p>\nthe people. In a town the size of Inverness there are bound to be people coming in\nfrom the rural areas for their shopping, and many of them would come to the nurse if\nshe would only try to build up this service. The provincial department Should also j*\ntake more responsibility in obtaining suitable quarters for her if she does not have\nthe initiative to go ahead and get them herself.\nWe left Cape Breton and drove on to Pictou on Saturday afternoon. We felt\nlast we had had a very interesting and a very profitable time in our three weeks of\nsurvey work there. I learned a great deal about the problem. They are much greater\nthan I had realized and their shortage is more acute. The country is very lovely and\nit should be a very nice place to work, if only there were more nurses and there was\n 1\nnot the frustration of so much to do and so few hands to do it. There definitely needs\nto be more guidance from the provincial department nursing office. If only there could\nbe someone appointed as an Educational Director, to help the nurses keep up with the\nlatest information in public health nursing and give to them some inspiration. One felt\nthat they were most happy to have someone from outside with whom they could talk over\ntheir 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\ndeveloped and they simply have not time to take on more and yet if they don't, other\nworkers will be put into the field*\nWe stayed in Pictou at the Braeside Inn on Saturday night and on Sunday drove\non over the Sunrise Trail through Pugwa^sSand Mockton to Fredericton, where we stayed\nat the Lord Beaverbbook Hotel. A new one of the Lord Elgin series. It was very hastily -i\nconstructed and was made ready for the Centennial which was held last week in Frederictoi\nIt has a very beautiful location, right on the river and a promenade at the back goes\nright along the river bank.\n -54-\nNEW BRUNSWICK\nAugust 2, 1948 - Meeting in Dr. Melanson's office at 10 a.m. with Dr. Melanson, Miss\nHunter, Dr. Trask of Saint John and Miss Siemens of St. John, V.O.N. This comprises\nthe provincial consultant committee,\nu u a ^^^J^' Vel&iaaon had been sent the list of questions which we had drawn\nup 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.\nDr. Baillie started off in the usual manner by telling them about the Survey.\nWe then asked for their major public health problems. Without any hesitation they all\nsaid - lack of trained personnel. This is really very acute in New Brunswick. We asked.,\nwhy there was such a lack of public health nurses. The main thing seems to be that the\nnurses are not provided with cars and they must have one. At the present time they\nreceive In mileage, 100 for the first 8,000 miles; 9* for the next 4,000 and 8* for\nanything over that. The Government will buy a car for the nurse and she has three years\nto pay for it at a very low rate of interest. Even this, however, is too much for the\nnurse to undertake when She is probably just finished her University course and is in\ndebt for it. They could take on graduate nurses without their public health training\nbut here the problem of getting a car is even greater. A second reason is that it is a\nrural set-up and they have to take a lot of responsibility with a minimum of supervision\nand direction. The young nurse feels this very much is almost afraid to set out on\nher own. They offered scholarships for training, the scholarship amounts to #500.00\nand they must agree to stay for two years. This is only a verbal agreement. There has\nnever been any limit to the number to be given because they have never had too many\napply. Actually, since 1943, they have only had 5 or 6. Last year there was only 1,\nand the year before that, none. The salary is very little, if any more, than the\nnurses are getting in hospital and is not as much as the D.V.A. can give. Apparently\nthere has been a great loss of nurses to the D.V.A., who can offer so much higher\nsalaries. There are only about ten nurses on the Health Dept. staff. They lost four\nlast year and are losing three now and they are having three more to replace them. I\nthink they will all, or practically all, be public health trained. In addition to the\nJfept of Health staff, there are 8 centres where there is a V.O.N, nurse, about 20 V.O.N,\nnurses in all. Saint John city has five nurses, T.B. Association, Saint John, has two,\nV.D. Clinic, Saint John - one. In Moncton their is a school nurse and also a T.B.\nnurse, supported by the Gyro T.B. Association. In one or two other centres there are\nalso specialized services.\nThe population of New Brunswick is some 480,000. If there were to be one\nnurse for 5,000 people, which is needed, about 90 nurses could be employed. They\noutlined the counties, the number of nurses, and the medical officers in each. Miss\nHunter will send me a list. Each county has its own Board of Health. Five counties\nhave to have bi-lingual nurses, This is another difficulty. We then discussed the\nshortage of doctors and why. It boils down to the fact that doctors will not come\nbecause of the salary. Dr. Trask said those he has are only there because they have\nsome other income. He did not feel that they could* live on their salary. They stated\nthat the public are ready for the service but they just cannot supply it. They get\none program built up and the nurse goes and perhaps the area is without a nurse for j\nsome time. They did not seem to feel that any one particular service was a gaxj greater,\nproblem than another. The nurses concentrated on the greatest need. In some places\nit is one service, in another another service. For example, in Westmoreland, they are .\nconcentrating on the school and child welfare service. They are trying this out as an\nexperiment. Miss Hunter is building up child welfare conferences. She has some 45 and\nthese are held in very small centres. Sometimes not even in a village. It id amazing\nto them how the rural people will come. At first they seem to be just immunization\nclinics and the nurses did not like this. But once the immunization is over they are\ncontinuing to come and some mothers are bringing babies much too young for immunization\nyJdi\n -109-\n^?HS^b!lM^+B^h\u00C2\u00B0Puapparently has secured it fro. them. If they have very poor\nteeth or eyesight they have two dentists and an optometrist to whom they may refer\ncases, that is patients who do not have their own or who find difficulty in paying.\nThe Patients will pay a third and the company pays two-thirds. This amount being\ndeducted from the pay-roll at the rate of one dollar per week. They try to folaow up\nand do a routine physical examination every one and a half to two years. They have\ninsurance 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\nfamily.\nThe second phase of the program is the first aid. This is made an opportunity\nfor health teaching. During the time that I was in the office only about a dozen\nemployees came in for consultation and treatment. Some of these were for straight\nhealth consultation. Miss Bishop said that more come in for this than for first aid.\nThere is a very friendly feeling in the plant. All those on the office staff and the\nexecutive group call each other by their first names and one has a feeling that the\nnurse is frequently consulted. I notieced that she was wearing a pin \"Safety Committee\"\nThe first phase of the program is educational, as mentioned previously, they are doing\nquite a bit of work in relation to nutrition. They feel very definitely that the worker\n. must be happy in his job and they try to solve any of the little mental hggiene problems!\nwhich might arise. This year they have obtained the service of the Toronto? night class-'\nes and have referred several to them. Miss Bishop seems to make very good use of the\ncommunity resources. She knows them and expressed a desire to become better acquainted\nwith the individual worker. One has the feeling that she uses every jbossible opportun- '\nity to refer the employees to the proper agencies when it is necessary. If there is a\npre-natal case, employed by the company or if it happens to be the wife of one of the\nemployees, she refers them to the pre-natal classes conducted by the various agencies\nin Toronto. Because staphylococcus infection is one of the hazards of this industry\nor rather one of the dangers to the public buying the product of this industry, there\nis an inspection of the hands and skin of the workers every morning. If there is any\nevidence of infection they are moved off the job if they happen to be handling or are\nin direct contact with the ingredients of the food produced. Dr. Harrison said it was ,,\nthe only baking industry in Canada which carries out this inspection and he seemed\nquite proud of it.\nOne had a feeling with Miss Bishop that very definitely she was putting her\npublic health nursing preparation and experience to very good use, even though there\nare only about four hundred employees, she seemed to be quite busy. She feels that\nevery industrial nurse should have a generalized course. That the hazards of the\nparticular industry have to be learned on the job and that more about industrial nursing,\ncan be learned through refresher courses, institutes, etc. She felt very definitely\nthat one needed to have had some community experience.\nLater on in the afternoon, Dr. Henderson took me to the Dupont plant where ;|\nthey make bread and cakes. This has considerably more employees. Miss Guy is also\na public health nurse and carries on much the same type of program as Miss Bishop.\nThey seem to be using quite a few biologicals, giving vitamin BI, Beminol, StafKyloco-\nccus toxoid, etc\u00E2\u0080\u00A2 J\u00E2\u0096\u00A0\n2. Colgate, Palmolive, Peet. This was the second industry visited. It is on Natalie a\nStreet. The nurse is Miss Grogan. She has not had public health. Her background was I\nprivate duty and for the last ten years she has been in this industry. They have about\nsix hundred employees, nearly fourhundred of whom are men. In addition there are two\nhundred and twenty-four office employees. I was not conducted around this plant so I\ndo not know very much about the set-up. The chief hazard seems to be burns. The\nmedical room is on the first floor and is referred to and named - the First Aid. It\nconsists of an outer office in which the nurse has her desk. A middle room, quite a\nlarge size which is the dispensary and two small rooms off of that in each of which\nthere is a bed for patients to rest. Miss Grogan is full time. There is a doctor on\n -55-\nThis has been very gratifying to the nursing service as they really want to do a\npiece of educational work in child health through these conferences. I think thia\ndisproves the theory that you cannot have child health conferences in rural areas.\nMiss Hunter is very insistent on using the word \"Conference\" instead of \"clinic\". The\nneed for personnel is so great that they do not know where to start. For example\nGloucester 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.\nFor three to four months ln the winter the roads in the country are impassable. A\ndoctor stated that one of the most discouraging things about public health is that you\nget your teeth into a problem and before you finish it you have to start In on another,\nthere are just so many problems. Saint John has the second highest infant nortality\nrate in Canada, Dr. Trask attributes this mostly to poor housing. Of 1,300 houses\nwhich were ordered demolished in 1932, 1,120 are still standing. New Brunswick as a win\nwhole has the highest infant nortality rate in Canada.\nIn trying to find out what they consider their biggest service problem they\nfinally said that probably it was tuberculosis. In New Brunswick the nurses do the\nimmunization and vaccination everywhere except in St. Stephen. There the doctors\nobject to the nurse doing anything for the school children. She does the immunization\nhowever, for infants. No one knew why the doctors made this distinction. Dr. Trask\nhas never approached them on the subject.\nIn relation to mental hygiene, there are no facilities. The nurses are doing\na 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\nnurses or the doctors, in mental hygiene. Dr. Trask says he did'nt know anything about\nit and did'nt want to know. The nurses felt that the doctors should have more mental\nhygiene and that they should act as consultants to the nurses in this effect.\nWelfare for the province of New Brunswick is under the Minister of Health.\nThere is a Director of Old Age Pensions and Blind. There is a provincial Child Welfare\nOfficer, who is responsible to the M.O.H. This is an untrained person. There is a\nC.A.S. representative in each county. Only a few of these are qualified workers.\nMiss Hunter stated that one-half to three-quarters of the T.B. problem is not nursing\nbut welfare. She feels that the nurse should not have to do this. It is just another\nthing added and they get more bogged down than ever.\nAfter lunch Miss Hunter, Miss Siaman and I met together. We discussed the\npreparation of the nurse. They both stated that nurses are dissatisfied with their\ncourses. Miss Hunter said - dissatisfaction is so general that there must be something\nwrong. They felt that there is not enough given on mental hygiene. Sometimes it\nvaries with the year the course is taken. For example, at McGill, one year when Dr.\nSilverman gave the course, it was excellent. This last year he only took two or three\nlectures and then was followed by another doctor whose lectures were largely psychiatry I\nAlso, the social ease work which was given at McGill was very poor and the field work\nopportunities are not good enough. They do not have enough help in working out the\nreal problems, or at least, in working the problems through to a solution. They feel ''\nthat more is needed on public speaking. They get a lot of things they already know,\nbut they want to know how to apply this information. What Miss Sieman and Miss Hunter\nfelt is that perhaps they are looking for too much in the course and that after a year\nor two back in the area they realize what value they did get from it. They go to the j\ncourse with the idea that they are going to get everything and all their problems will\nbe solved. It would be an idea to see what could be done through Miss Deanings's\nmerit system test in sorae university, to build on the knowledge the student already\nhas. Let them know the facts they should know but do not know that they will have to\nobtain these themselves, and then concentrate during the university course on teaching\nthen how to teach public health. Both Miss Hunter and Miss Sieman felt that there was\nnot enough on the basix principles of recording. They said it is a rare nurse who can\ndo a good job on records. For one thing they are done at the tail-end of the day j,\nJm\\n -56-\nwhen the nurse is tired. This is perhaps, bad. They need more on V.D. More and\nmore venereal disease should be included in the generalized program and in so many\nplaces she is not being given instruction on this. All nurses should be taught to\ndrive 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\nof her nurses have remarked on this. They felt that the hospital supervisors and\ninstructors do not have any idea of what we mean by incidental teaching. The nurses\nare not given this idea in the hospital and it is very difficult to pick it up in\npublic health. There is a great need for more teaching in the sanatoria so that the\npatients will be better educated when they come back to the. district. Miss Hunter\nstated very emphatically that the doctors need to be taught how to work with nurses.\nBy the she meant that so many of the doctors do not seem to know how to plan a\nprogram and that they do not realize that they must plan it along with the nurse. In\nsome of the areas the nurses have clerical assistance. The clerk is paid on an hourly i\nbasis. The nurses are free to obtain this assitance wherever and whenever they can.\nConpleted key form with Miss Hunter. Felt that this should be done for the zpcmkx\nprovincial department since the service in Saint John is somewhat different and also >\nthe one in Moncton would only be one of the rural areas. This should probably be\ndone for each province. There is also need to allow more time in our visits to spend\nwith the provincial workers. They are, after all, the ones who direct the policy.\nMiss Hunter is to send me her own job analysis, the statistical information, a list\nof the counties with population, nurses, etc., a copy of the agenda for the staff\neducation program, and a copy of the lectures given to the Normal School students.\nAfter dinner we drove to Saint John, Dr. Baillie going with Dr. Trask and\nMiss Sieman coming with me. We arrived at the Admiral Beattie to find that our\nreservations had been cancelled. We obtained rooms in a very nice old house at 30\nQueen Street. This is a place which the hotel sometimes use when they have no place\nfor guests. It was a very lovely home, beautifully furnished. Saint John homes\nseem to be something like the homes in Boston. They are built right out on the streel\nwithout any lawn, and look like terrible places, but when you get inside, they are\nbeautifully furnished and very lovely.\nAugust 3. 1948 - At 8.30 in the morning met with the V.O.N, nurses and afterwards\ntalked with Miss Steman and completed key form. Miss SSfcman has built up a very\ngood industrial nursing service. It started at Eastern Textiles with the service\nbeing a purely health education one. Miss Sieman herself started this. (See form\non industrial service for further information). Miss Sieman gave me a list of the\nother areas where there are V.O.N, in New Brunswick. Moncton - 4; Sackville - 2;\nalso where they do school service and well-baby conferences; Newcastle - 1 where thej\ndo schools, tuberculosis and well-baby conference) Chatham - 1, schools, T.B., and.\nwell-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\nwell-baby conferences; Fredericton - 2, do the school work and well-baby conference;\nSaint John - 7 and supervisors.\nMiss Sieman has developed a very happy staff of nurses. She has done\neverything to make their work more pleasant and more interesting. When she first\ncame they were doing, very largely, a bed-side service. She has added pre-natal\nservice and the industry and the nurses like it very much better. There is no over- L\nlapping of the service with the Health Department as described in ttje key form a list'\ncontaining information to admissions and discharges is sent to the ealth Dept. egery\nSaturday. They also obtain referrals from the hospital. There are three hospitals\nof which the largest is the General. There is a Catholic hospital and a Salvation\nArmy hospital. There is not so much co-operation with the latter two. Miss Sieman\nwould like to have more nurses and do a larger industrial program and start pre-natal\nclasses. They have recently added some of the outside areas of Saint John.\nIn the building which houses the V.O.N, there is also the Children's Afcjj\n -57-\nAid Society, Family Welfare and the Tuberculosis Association. Following my talk with\nMiss Sieman I went upstairs to see Miss Clark who is a tuberculosis nurse. In Saint\nJohn the T.B. work is done by this private organization, which is financed by the seal\n\u00E2\u0080\u00A2^^'u ^! s*af\u00C2\u00A3ucon8ists of Miss M.L. Clark, who took her public health in Toronto\nand Miss MacDonald who has not had public health but has had some post-graduate work\nin tuberculosis. Did not meet Miss MacDonald as she was away on her holidays. There\nis one clerk. Miss Clark says they could use another nurse but she wants to have a\nqualified one, that is, one with public health. But because of the low salaries she\nfinds it very difficult to obtain anyone. They can only offer $1,600. Miss Clark\nherself is getting less than $1,800. They have a clinic twice a week in the afternoon\nfrom 2 to 4 p.m. except during the month of July and August. The medical staff of\nthe Tuberculosis hospital give their services free. They are able to fluoroscope only,\nthe x-raying is done at the hospital. There average attendance is around thirty. The\nnurses do the home supervision of Saint John city and county. They teach the case and ,\nthe family the care necessary to prevent the spread of the disease. They are all\ntaught to wash and soak the linen in lysol before washing. The patient should have\nseparate towels and that the dishes should be kept separate with a separate tray and\npan for sterilizing. This is taught for all cases at home, including post-sanatorium\ncases. The frequency of visits depends on the time and the case. Their case load is\nas follows -\nFamilies - 642\nCases - 363\nContacts - 704\nIn 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.\nnurses, also the V.O.N., patch test any contacts in the homes that they are visiting.\nSample of the records was obtained. They use a family folder and a clinic slip. They\nhave a list for home visits which are kept in a black book carried by the nurses. This\nslip is attached to the record for the doctor's information when a clinic is held.\nThere are a great many social problems, these are referred to the Family Welfare. As\nthe office of Famil Welfare is just across the hall there is a much better chance of a\ngood working relationship. The head of the Family Welfare is a trained social worker.\nMiss Clark says they report their eases where there are social problems, these are not\nonly where material relief is necessary. I felt that Miss Clark had rather a good\nunderstanding of the social aspects. She feels very definitely the need for a medical \\nsocial worker in the sanatorium. She feels also that the nurses are not getting enough\non teaching in their undergraduate course. As it is not necessary to have affiliation\nin New Brunswick, many of them are afraid of tuberculosis. The teaching done in the\nsanatorium where they are at present desperately short of nurses is very poor.\nConsequently when the patient comes from hospital he has not been educated as he should\nand needs closer sxq>ervision at home. Miss Clark is not able to call regularly at the\nsanatorium. The nurses are asked regarding home conditions for the case is ready for\ndischarge from the local Sanatorium. However, many of their cases are in sanatorium!\naway 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\na job analysis form and send it to me later. She will fill it in with the idea in\nmind of analysing the work done in a specialized T.B. service with respect to the amoun\nwhich is nursing and the amount which is welfare,\nA couple of days later I saw Mrs, Warnford who is head of the Family Welfare ;\nBureau along with Miss Clarke. Mrs. Warnford is a trained social worker. She intended\nleaving her work shortly after the war but at that time became very interested in the I\nhousing and she apparently is the one who is working closely with other officials and u\npushing the City Council and stimulating their Interest. Mrs. Warnford spoke of the\nclose working relationship with Miss Clark and the T.B. problems. She suggested some\nplaces to which Miss Clark might take me to show me the housing in the city.\nOur first visit was to the emergency housing shelter where we saw a husband\nwho was very nice indeed. This was wd^obdc one of their better tenants. We then .\n -58-\ndrove around to Bookmood Court Apartments which are being built. They are going to rent\nfor something like $80.00 a month. Mrs. Warnford feels that by paying $15 to$lS dollars\na month and bating your own place you are paying more than straight $60 a month rent.\nNot all agree with this. We then saw some of the other housing developements such as\nFundy Heights which were started by the Insurance company and taken over by the Canada\nMortgage. Dr. Trask happens to have one of these houses.\nWe made a visit to a family on the top story of a very rickety old house. They\nwere three flights up. We went in the front entrance. The first flight was dimly lighted. The last two were dark as pitch and I had to feel my way. Only a little over a\nyear ago a rear exit was made for this family. This was somewhat lighter. There were\nfourteen children in the family. The father is an old thoro$kasty, now working on a\nboat. The mother is of somewhat dull mentality. The two girls who were at home had\ntaken hold and really tidied the place up. The older of the two girls, 13 years, was a ,\nvery attractive youngster and very nicely spoken. What an environment for her to be in.\nMiss Clark is a very nervous individual and it would not be possible to visit with her in\nrelation to teaching which she does in the homes.\nIt is too bad that in Saint John this program is a specialized one. It is being\ndone, I am sure, quite efficiently by Miss Clark^, but would be so much better and so\nmuch more interesting to the nurses of the city department if it could be included in\ntheir program.\nThe same is true of the V.D, work. Visited the clinic on August 5th. Mrs.\nMcLaren is the nurse in charge who gives the treatment to the women. Women's clinics\nare held every day except Sunday from 9 to 12.30 a.m., and from 2 to 5 for five days a\nweek. The mens clinics are held every evening from 6 to 7. Internes from the hospital\ngive the treatment at the men's clinic. Routine treatment is given. If a case comes in\nwhich has not been diagnosed they are referred to Dr. Emmett. If they are suspects the\nnurse takes blood and smears, and if diagnosed positive, treatment is set up. This may\nbe done without the doctor having seen the patient. The penicillin treatment has greatly\ndecreased 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\nfield work with the V.D. division in Vancouver. She follows up all cases. Every new\npatient is referred to her. She is supposed to trace the contacts. This may be done by\nsending out a note or first, making a visit. Both Mrs. McLaren and Mrs. Dunlop state\nthat there is very little delinquency.\nAugust 5. 1948 - Saw Miss Lamb at the V.O.N. Miss Lamb is a student from McGill. She\nis taking the degree course and I was anxious to find out about it. She has completed\nher first year. There are about ten in her class. They are asked to get field work\nbefore entering the course if at all possible. It was not possible for her to do so.\nIn her first year she took public health nursing; teaching; trends in nursing; psychology j\nnutrition, phsyiology, this includes a three hour lab. and is taken with the pre-meds;\norganic chemistry which also Includes a three hour lab; and social medicine. She then\nhas to have two months field work. She is having her field work with the V.O.N, They\nall have to do this. She is taking three months. The first month without salary, the\nlast two months they get a certain amount.\nIn her second year she will soci/ology; education; mental adjustment; social medicine;\npublic health nursing and the field work will be in the various agencies around Montreal.\nAsked Miss Lamb in relation to her physiology if she did not feel that she had had enough r\nin her preliminary nursing course for public health. She thought that physiology gave\nher a much better understanding than she had had previously. Organic chemistry, possibly\nthere is not much in this which is going to assist her in public health nursing.\nFollowing my interview with Miss Lamb, went with Miss Mclntyre to the\nindustries which she goes to from 9 to 10 every morning. This is a large departmen\n 5S\n-59-\nt^T* i\u00C2\u00A3^+J\u00C2\u00A3! * second industrial nursing service started by the V.O.N, in Saint J\nJohn. Tha store has about 250 employees. Unfortunately, the personnel manager with,\nwhom the nurse works is not very cooperative. The room ised by the nurse is a sfifiinS\nroom, it has a bed, a wheel chair, a small table and first aid cabinet. There is no\nrunning water. The nurse has tried to get a card for all new employees. It is\nsupposed to be routine that new employees are sent to the nurse. There is no routine\nphysical examination. As Miss Mclntyre is there for only one hour each day, it is\nalmost impossible to do anything more than a first aid service. The average daily\nattendance is July was 4.19. While I was there two women came in to have bandages\nreplaced on their ankles. Bothmx of these seemed to be chronic. Miss Mclntyre has just\ntaken over the service and is planning to develop it as far as possible. She has been\ntrying to get the records in order and is going to try to arrange to see three or four\nnew employees each day. However, the difficulty seems to be lack of cooperation with\nthe personnel manager. One wonders how far we are justified in using public health\nnursing personnel to develop industrial nursing services such as this.\nInterviewed Miss Law, Registrar of the New Brunswick Registered Nurses\nAssociation, 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\napplicants, but the smaller ones are sometimes finding it rather difficult. The three\nsmall hospitals which have schools are - Campbellton with 70 beds; Merimache with 65\nbeds and Woodstock with 65 beds.\nStudent nurses in New Brunswick have psychiatric affiliation but do not have\nany T.B. affiliation. There is no public health nurse on any hospital staff. Nursing\nassistants are used in hospitals. The C.W.T. training program is still going on and\nthese girls are quickly absorbed. Some hospitals are taking in their own and giving\ntheir training. Miss Law feels very definitely that the difficulty\u00C2\u00B0Che provincial\ndepartment of obtaining public health nurses is because of having to supply a car.\nAsked regarding salaries in hospitals - the Saint John general is the best pay. Chief\ninstructor, nurses - $145 a month plus maintenance. Her two assistants - $110 and $100\nper month, plus maintenance, respectively. The obstetric supervisor who has had a post\ngraduate course ln obstetrics and has had three years experience, receives $145 plus\nmaintenance. Floor supervisors with two years experience, but no post graduate course,\nreceive $110 and maintenance. General duty nurses with two years experience and over\nreceive $115 with meals and laundry only. In the smaller hospitals the general duty\nnurses receive $1260 to $1380 a year with full maintenance. Comparing with the public\nhealth nurse who finds it difficult to get board at $35 or $40 a month, the public\nhealth nurse is not much further ahead, if any.\nAugust 6. 1948 - Had lunch and interview with Miss Ramsay who was the social service\nworker at the Saint John General Hospital. This hospital had a social service dept.\nabout twenty years ago but were not satisfied. It has started up again this last year\nwhen Miss Ramsay'took it on. Miss Ramsay has had several years teaching experience\nand has recently taken her social work at Dalhousie. The understanding when she went\nto the department was that 75% of her time would be spent investigating the financial\ndetails of admission of patients and 25# in case work. I think that she has readjusted\nthis now. We discussed social work in general and medical social work. I went over my\nnotes of the Hamilton Institute and gave her an extra copy. She seems very interested\nin her work but she has a hard row to hoe. She spoke very highly of the cooperation\nof the nurses.\nAugust 4. 1948 - Spent the day with the Saint John Board of Health nurses. Interviewed\nthe two nursew who were on duty, Miss Donovan and Miss MacDonald in the morning, and\nvisited the clinic in the afternoon. The staff of nurses consists of, Miss Jenning\nwho was on holidays and who acts as a senior nurse. Miss MacDoaald who is leaving at I\nM\n -60-\nthe end of the week is the only one with public health qualifications. Miss Wilcox\nwho was on holidays. Miss Thompson who is leaving to take the course in Toronto this\nwinter and Miss Donovan. Miss Donovan is the one who has acted as senior in Miss\nJennings absence.\nThe area includes the city of Saint John and suburbs and the county of Saint\nJohn. Previous to January of this year, three of the nurses did the school nursing p\nprogram and three did the infant welfare, including both infant and pre-school. This\nconsisted mostly of clinic work. At the present time Saint John city and suburbs are\ndivided among the six nurses. There are twenty-six schools in this area. These\nnurses also carry the pre-school. There are five clinics, one held each afternoon.\nThere are 29 schools in the rural areas. These are not definitely assigned to nurses,\nwhoever is available, goes. The work in these schools is done in the spring and fall\ndue to travel conditions. There is no infant welfare program in the county. Each\nnurse is provided with a street car pass. County work is done with the use of the\nBoard of Health car. A sanitary inspector drives this car and when the nurses want to\ngo to the schools the sanitary inspector drives them. He does his work as a sanitary\ninspector, 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\nhas been doing some experimental examinations in the schools. No high school work is\ndone, there has been no patch testing. Pre/-school immunizations are done in the rural!\narea in the schools at the same time as the school children. When they prepare for an\nimmunization clinic they let the teacher know when they are coming and send her consent\nslips. She sends them home and makes out a list of the children in the school.\nAccording to Miss MacDonald a great deal of the time is taken up with\npediculosis. There is no regular program of visiting the city schools. Children with\npediculosis are excluded and must report to the Health Office for re-admission. If a\nchild has had pediculi and they have been cleared up, he reports at the office. If j&sa\nthere are still nits he may be told to come back for re-inspection. This may happen\nover and over again until the families get into the habit of coming to the office.\nThere is one nurse in the office every aftecnoon for this purpose. There are sometimes\nlas'many as 100 children reporting. She feels that there is far too much time wasted on\nthis and that the teachers could take some responsibility.\nThe school program' consists of -\n(a) a general survey of the classes three times a year after holidays,\ndone in each class and there is a routine class inspection.\nThis is usually\n(b) Examination of grades 2, 3 and 5. Teeth, throat, hearing and vision. They do not\nweigh the children. Sometimes, if there are scales at the school, the teacher wiH\nweigh the children but the nurse has no record of the weight. Usually this examination\nis done by taking the children to some vacant room. There are no health service rooms\nin the schools.\n(c) Grades 1, 4, 6, 7 and 8 are given a less thorough examination. Sometimes this is\ndone outside the class and sometimes in.\nThe parents do not come to the school. Nurses send home notices of defects\nand try to do as much follow-up work as possible. However, since the nurses are in the^\nschool every morning, and each nurse attends two to three clinics in the afternoon,\nand it is necessary to be oh duty at the office one afternoon, this only leaves one or\ntwo afternoons a week for home visiting, and this must be divided among school and\ninfant welfare cases.\nIn relation to communicable diseases, the nurses do not report. For example,\nif they are told by a teacher that a certain child has chickenpox and that has not been\nreported to the family doctor, they wial not bother reporting it, at least they\n -61-\nhave not been requested to report it. The nurse does not make exclusions bf contacts*\nThis is done by the teacher. (See Communicable Diseases Regulations on card which is\nsupplied to all teachers.) The case must come to the Health Officer or the private\ndoctor for a certificate for re-entry.\nThere are no mental hygiene facilities. There is an eye clinic which is\nattended by one of the nurses every Saturday morning during the winter months. Cases\nare referred from the school. There is a dental clinic which is held every morning\nfrom 9-12.\nThe infant and pre-school programme is chiefly done through the Well-baby\nclinics, which are held every afternoon except Saturday, The babies are weighed and\nthe mothers are interviewed. In my observations, it seemed as though this interview\nwas very sketchy. The nurse sits down by the mother, while the mother is dressing or ,\nundressing the baby and the\u00C2\u00BB may be other mothers right nearby. Babies are immunized\nand vaccinated at the clinic by the nurses. They usually have a volunteer who draws\nthe records and sometimes weighs the baby. She writes the date on the baby's weight\ncard and on the clinic card. The average attendance at the clinic is 45 to 47. The\ntwo clinics which I attended, one at St. David's United Church and one at Portland St.\nUnited Church. At the first clinic there were 70, 35 were there for immunization,\nabout 10 were new babies. At the second clinic there were 47, and 28 were there fir\nimmunization* There were 2 new babies. A list is made by the volunteer of all infante\nand pre-schools who attend the clinic. These are checked by the nurse with the cards\nand serves as a count. This seems quite unnecessary. One of the nurses looks after\nthe immunization clinic, she makes out the cards. The baby's clinic records is taken\nto the office and the information entered at the clinic is transferred to a duplicate\ncard which is kept in the office. This is done so that when the nurses make home\nvisits they can refer and know what was told to the mother at the clinic. However,\nthe record of the home visit is not entered on the clinic card but only on the office\ncopy. Not very many of the clinic cases are followed into the home.\nIn one of the clinics I attended there was a volunteer* She, however, did\nnot do any weighing* In the second clinic there was no volunteer. There were three\nnurses. Two working on the Immunization and one interviewing mothers*\nThere is a very great need for nursing supervision and direction. Had a lon| ii,\ntalk with Miss MacDonald when I took her out on a home visit. She is the third nurse\nwith public health training to leave. The chief reason seems to be Mr. Mclntyre, who\nis the secretary of the Board. He seems to control the nursing situation. Miss\nMacDonald has frequently made some suggestions and I think she has probably done it in\nthe very best of faith. However, when those to tkw whom the suggestions are made\nhave left training and the one making the suggestions, they immediately rise up in\ndefence* This apparently has been the situation in regard to Miss MacDonald. She\nhas been said to lack tact. She has a very nice approach to the people when I saw\nher working in the clinics and also during the home visits. She apparently finished\nher course in Tbronto two yeais ago and is enthusiastic about public health* She did\nnot realize the kind of situation she had gotten herself into, and at the end of two\nweeks here when she discovered that there really was not medical officer of health,\nand when she found that the nurse in charge did not have public health training, she\nwent to Mr, Mclntyre and said she felt she had better resign. She was however,\npersuaded to stay on. Several little things arose following suggestions made by her\nwhich made her feel that she was getting in deeper and deeper but she resolved to\ncontinue since she did not want to leave with bad friends. This has worried her very |\nmuch and she has lost a lot of sleep over it. She really feels very upset about the r\nwhole thing and may be lost to public health. She told me at the end of ray interview\nthat Dr. Trask had asked her to resign. This is really a very bad situation. The\ngirl is leaving\" feeling very frustrated. However, Dr. Trask cannot do very much about j\nit I suppose. He also is in a very difficult spot, having to sit in the office with\nMr. Mclntyre. The only kind of person who can be put in this situation is a fully fl\n -62-\nqualified public health nurse who has had some years of experience and she must be\nput in charge. As Miss MacDonald says, it is absolutely an impossible situation,\nwhen a worker is trained to be put under a worker who has not had training. If\nmore supervisors were qualified and were good administrators were available and were\nemployed it would be much better use made of the existing public health nursing\nstaff. This is true in Saint John and in many other places.\nDr. Trask also has Charlotte county. There are two nurses there. One\nprovincial who has a rural area and the Island and one who is a Red Cross nurse\nsubsidized by the government. She does the work in Saint Stephen and Milltown.\narea was not visited.\nThis\n -6>\nPUBLIC HEALTH NURSING SERVTOE OF WESTMORLAND. KENT. AMD ALBERT COUNTY. N.B.\nqt u^tlr,^\u00E2\u0084\u00A2^ John, Sunday, Aug. ^th and after a very pleasant drive via\n$r***\u00E2\u0080\u00A2 *\u00E2\u0080\u00A2* a-ange for\nc^thfpLCet\u00C2\u00A3 volunteers. They sometimes give sorae supplies such as oil-\nIE \u00C2\u00AB\u00C2\u00ABM.?!+CSferBnC!i at ?tdiaC JS hold offioaUy ft'om 10 to 12 a.m. and 2 to 4 p.n*\n2iJLf?ft2JT~ \u00C2\u00B0n, \" 9#3\u00C2\u00B0 ^\u00C2\u00B0 6 with ^^ a break for *\u00E2\u0096\u00A0**\u00E2\u0080\u00A2 0n the day we\n\u00C2\u00AB \u00C2\u00BB ,i* * !f!*W!re>J!rarses and 2 volunteers. This will not happen again since only\nMiss Robadot wiH be left. She will however, have the assistance of the nurse from\nanother county. The nurses here, give the immunization. Miss McLagan gave all the\nimmunizations and the vaccinations during the day and the other three nurses conferenced.\nIn this area, and it is probably true in all the provincial conferences in New Brunswick,\nthe nurse weighs the baby and conferences with the mother while she is dressing and\nundressing the baby and the conference may be continued after the mother has finished if I\nthere is time and if there is more to discuss. Asked the nurses about this, why they\ndid not have a volunteer to weigh the baby. They feel very definitely that the nurse\ncan see so much if she sees the baby naked on the scales and that it is much better for ,\nthe nurse to do the shole procedure. They would like it too, if this same nurse would\ndo 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\nmissed if the nurse did not see the baby with its clothes off. For exaaple, there was\none premature baby which had a leg paralysis, which would have been completely missed\nhad they not had the mother undress the baby. There are rashes and other defects which\nare often uncovered. This system has a great many points in its favor and after all it\ndoes not take very long to weigh the baby. In the larger centres it would be necessary\nto have more than one scale. They had two at Shediac, For a new conference with such\na large attendance the work was very well organized and the whole thing ran very smoothly ,\nVolunteers had been told in the introductory conference that they are the\nhostess. They are responsible for setting up the conference, seeing that there is heat, -\nand that the place is clean. Sometimes they fall down on this. They pull the records,\nput on the name and make out the immunization list and generally see that the clinic\nfunctions smoothly. This seems to me to be the right attitt#\u00C2\u00A3de towards the use of\nvolunteer assistance. One volunteer at Shediac is Mrs. Birk who was the director of\nnursing for the course at Montreal University. She is a public health nurse.\nTuberculosis - All the follow-up work that is done outside of Moncton is done by the\npublic health nursing service. In Moncton there is a tuberculosis nurse sponsored by\nthe Gyro Club, She also attends the Dept. of Health clinic to which come many of the\ncases, or rather all of the cases from outside. Miss McLagan feels that the public\nhealth nurse of the district should be in the clinic when the patient comes in as this\na very important contact to have. There has not been to date too close a working\nrelationship between the Gyro nurse and the public health nursing service, but this is\nbeing improved and cases are being reported better. All the positive sputum cases are\nhospitalized except for those, I do not think there are many, who refuse. The nurses\npatch test all children who are contacts. It seems that the general administration of\nthe tuberculosis program in New Brunswick is not at the same stage as it is in Nova\nScotia and consequently there has not been so much follow-up for the nurses in N.B.\nMiss McLagan, however, feels that a great deal of the contact work can be done through\nthe general health education program in the schools and the child health conferences, |\nFor 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\nthe public health nurse should play and perhaps less of the function of the.policeman\nfollowing up in the homes, as is so often the case. Miss Mclagan stated that probably \u00E2\u0096\u00A0\n20* of the work of the nurses in relation to tuberculosis is welfare. They make very\ngood use of the Children's Aid Society workers out in the county and in the city of\nMoncton of course, there is the newly created Welfare Bureau under the direction of\nMiss Reynolds* .jl\n -66-\nS^SS^\"*?1* T^1 h^i9ne teachin8 is ^^ntal in the homes, child health\nhfLnr\u00C2\u00ABf^ ^+4SCh\u00C2\u00B0\u00C2\u00B0i: ^6re are no Jollities and no testing facilties under\nS! 2?^ fUGation. Mr. Chapman apparently, is able to give very good advice to\nthe teachers in relation to special mental hygiene problems. Miss McLagan feels that\n\u00E2\u0096\u00A0toe public health nurse is equipped to give the advice to teachers regarding any child\nwho is shy or who has a discipline problem, provided that the behaviour of the child\nis not too anti-social.\nAdult Health Education - The chief adult health education is in the form of Miss\nMcLagan*s contact with the teacher. When a new Home and School Association is formed\nshe is there to talk to them and she also gives talks to the Women's Institute.\nShe has been doing a very interesting piece of work with the Interprovincial\nHome for Women, which a sort of reformatory home for women between the ages of 16 and fr\n30. I believe they are there for anywhere up to four years. Every week during the\npast winter she has been giving an hour of instruction. She has had to start with\nvery simple things and has discussed table manners, use of cosmetics, cloths to wear, -\netc. She has also shown films and given demonstrations.\nCommunicable Disease Control - Sanitary Inspector in each area does the placarding.\nIf there is a comwmicable disease in the school, the teacher will phone the nurse. If\nit is one of the minor diseases she tells the teacher to exclude the children according\nto the card. If there is any trouble, the nurse will go, and of course, if it is a\ndisease such as scarlet fever, the nurse will go immediately.\nImmunization - the nurse does the inoculations and vaccinations in the child health\ncentre. In the immunization clinics which have been organized in each school to date,\nthe doctor has done the immunization. I do not know if this plan is to be continued\nor not. The organization for the school immunization clinic has not been as good.\nHere, 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.\nMiss McLagan told us that when they first covered the schools in Kent County which was\nher first year here and also Dr. Landry's, before he took public health, no records\nat all were made out.\nVenereal Disease Control - This is included in the program for follow-up. In this\nAct tho public health nurse is defined. She is not defined in the Public Health Act,\nand it is stated that she is empowered to have any person whom she suspects as having\nvenereal disease examined. Apparently the present clinic is in the city hespital and\nis a terrible affair. This will automatically cease as the patients can go to their\nfamily 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\nrespect.\nSanitation - The system of sanitary inspectors is a very antiquated one in these\ncounties as in the most of New Brunswick. Apparently there are no trained men. In\nWestmoreland county the nurse spends a lot of her time fighting with the sanitary\ninspector over the fumigation of schools. They apparently do this frequent and for\nno apparent reason. If the sanitary condition in the school needs reporting the nurse\nwould perhaps visit the trustees and she would also report to Mr. Chapman. If water\nsupplies are taken routinely as stated in the manual there would be a charge of $1.00.\nMiss McLagan has not felt that she would be justified in pushing this as that would\ntake perhaps $200.00 of the special grant which is given for various services.\nStaff Education - The public health nursing section of the Graduate Nurses Association\nin New Brunswick for the area of Westmoreland and Cumberland County in N.S. which\nbrings in the Nova Scotia nurses association, hold regular meetings several times a\nyear in Sackville. All the public health nurses of the area attend and they have very\nfine programes. They all find this very stimulating. In addition there is a\n -67-\nconference in the spring and another in the fall in Fredericton to which all the\nnurses go. (Notes from this may found in the provincial form).\nClerical Assistance - it is the policy of the public health nursing service of New\nBrunswick to obtain partitime clerical assistance where such can be obtained. Miss\nMcLagan states that one-half of the time in the office could be saved if a clerk were\navailable. For some reason, I think it is a personal one, the clerk in Dr. Landry's\noffice cannot be used by the public health nursing service. They have tried the\nservices of one or two part-time people who have been recommended by the National\nEmployment Service. These however, have proved unsatisfactory. They are interviewing\none this week to see how she will work out. There is a terrific amount of clerical\nwork to do, especially in connection with immunization. When a child is immunized at\nthe child health centre a record of that is made in five different places. Suggested\nthe use of a card which would be a permanent filing card and would also save the making\nout of the lists and the recopying of them.\nWelfare * There are not many welfare workers. Miss Mcijagan apparently has been very\nactive ln the formation of the Welfare Bureau, which has only been going for the last\neight months or so. There are two trained workers in it and it however, is only for\nthe city of Moncton, although Miss Reynolds spends some time in the parish. In the\nschool survey which Miss McLagan did she estimated rather carefully, that 18* of the\ncases reported represented welfare problems0 She made this estimate in connection\nwith the plans to create a Welfare Bureau and to point out the need for it.\n -68*\nVICTORIAN omrep QF NURSES - MONCTON. M.,B.\n\u00E2\u0084\u00A2t%n^!S\u00C2\u00AB lZ ^t thT t\u00E2\u0084\u00A2 f0Ur nUrSeS Senres *\u00E2\u0080\u00A2 cit7 of Moncton only and does\nJ'L^^ of the suburbs. Miss Fowler who is the nurse in charge was away on\nholidays and Miss Joy Clark was acting as senior nurse. Miss Clark has only been with\nS^f^f f\u00C2\u00B0Lone ?ef\u00C2\u00B0 !he iS a ^aduate of the Bachelor of Nursing course at\nMcGill University. I do not believe she has had any previous experience. The V.O.N.\nservice here is much the same as other V.O.N, services except that they operate a Baby\nclinic once every week except one Thursday a month. On this Thursday, which is a regular\nBaby clinic day, an Immunization clinic is held. Dr. Landry does the immunizations in\nthis clinic, A vaccination clinic is held twice a year with Dr. Landry doing the\nvaccinations.\nAt the Baby clinic there is no volunteer assistance. There are two nurses, one\nwho does the weighing and some of the conferencing and one who does conferencing only.\nThe average attendance is twenty-five to thirty except in the summer time when the\nattendance is rather low.\nThey did start pre-natal classes this last year, Miss Clark taking the classes.\nThey consisted of eight to ten lessons and when they started out there were quite a few\nbut the attendance dwindled down to four at the end. I do not know why this is except\nthat I would judge that Miss Clark might not be a very effectual teacher. Apparently\nthe doctors do not refer pre-natals. Most of the patients referred are referred by\nthemselves or a friend. They have twenty-eight pre-natals on their list now. They\naverage about three home confinements a month.\nIn relation to infants, they are all followed for one year for home visiting.\nDr. Landry is not on the Board of the Victorian Order of Nurses. A monthly\nreport is sent to Miss Hunter. This seems to be a hangover from the old days and there\nis no particular reason why they send it to her*\nThe last morning in Moncton I visited the Tuberculosis Sanatorium which is\nhoused in one of the buildings formerly operated by the R.C.A.F. Miss Bartch is the\nnurse in charge. There are 120 patients. In addition to the matron, Miss Bartch has\nnine graduate nurses, one trained attendent and the remainder of the staff are nursing\naides . I asked particularly about the salaries. Graduate nurses receive $135 a month\ngross. Trained attendants, $100 a month gross and the nursing aides, $80 a month, gross\nThe salaries for graduate nurses, considering that they have living-in is considerably\nbetter than the salary paid to the public health nurses. Miss McLagan told me that her\ncheque amounts to $94 a month. She, of course, has some deductions for her car, it is\nimpossible to get living outside for less than $50,00 a month.\nIn the afternoon went with Miss McLagan and Miss Robodot to their Baby clinic .\nat Hillsboro, This clinic is he/kd in the Memorial Hall, They have a volunteer worker\nwho was a former public health nurse and a graduate of the University of Alberta course.j\nThey had 28 infants and pre-schools, 16 of these were vaccinated and 4 received inocula-f\ntions. Miss McLagan did most of the immunization and she also did some conferencing.\nThey follow out the plan of the nurse who conferences, weighing the baby. This seemed\nto be more of an immunization clinic than anything else and one wonders still if we are\ngiving enough to our nurses so that they can, in return, offer inducement to the public\nto return to the Baby clinic for other than the immunization program.\n -69-\nPRINCE EDWARD TST.AMnT\nAugust 12th to August 19th, 1948 spent on the Island. As I had been here previously\nfollowing the C.N.A. and had met the nurses, they had had an opportunity to complete\nthe questionnaire forms which were left with them. These were done very excellently\nand I have had an opportunity to go over them all with the nurses.\n. * 3ii addition to this and following our meeting, which was held in Friday\nmorning in Dr. Keeping's Office, I have visited with Miss Wheeler in her Summerside\narea and have attended a Tuberculosis clinic in Summerside and in Charlottetown. I\nhave also visited the hospitals, the P.E.I. Hospital in Charlottetown and Summerside\nHospital and have had an interview with Mr. Shaw who is superintendent of education.\nThere is not a V.O.N, service in Charlottetown, although just recently Miss Hall has\nbeen speaking to the Rotarians and they are quite enthusiastic about starting this\n- service. The opposition to it comes from the Dept. of Health. Miss Wilson feels that\nthere should not be another nursing service in the area, and if they wish a bedside\nnursing program that extra staff should be given to them to carry it out. Miss Wilson .\u00C2\u00AB\nseems to put a great deal of emphasis on the school routine and although it would not\nseem so from conversation, I believe that \u00C2\u00B1a actual practice that when other programs\nare suggested there is considerable opposition to the interruption of the routine\nschool program,\nA meeting on Thursday morning was attended by Dr. Keeping, Miss Wilson, Miss\nRoss and Miss Wheeler. It was unfortunate that Dr, Shaw was away on his holidays.\nHone of the tuberculosis staff were brought in. There had been sorae misunderstanding\nin that Dr. Keeping had the idea that we were to make a critical analysis of the\nprogram. Perhaps that is why there seems to have been sorae opposition to our coming\nalthough I had explained very carefully to Miss Wilson and her staff that we were not,\nin any sense, doing an evaluation. I think the misunderstanding on her part, if there\nwas any, was inexcusable. I must say that I have had the very nicest rece/ption from\nthe whole staff. Some of them coming back from their holidays to see me.\nAs stated previously, the greatest emphasis seemed to have been placed on the\nschool program. The tuberculosis work is done by Miss Tate and officially, she is the\none who does all the follow-up. She does delegate some of this responsibility to the\nnurse in the district but this has never been a definitely planned program and there\ndoes seem to be some confusion in the minds of the nurses, I believe also, there is\nsome resistance on the part of some of them to carrying out this part of the program.\nMiss Ross will not do it in Charlottetown nor does Miss Beer want to do it, Mrs.\nCameron has done a considerate amount because she likes doing the tuberculosis work and\nMiss Wheeler is also anxious-to do it. At the present time there has been no system\nworked out whereby the nurses have the records for the family. If\nSchool program seems to be pretty much routine. They of course, cannot visit ,\nall their schools during the year. I visited with Miss Wheeler, the one school in her\narea. Schools are open early in the rural districts of P.E.I, because later on there\nis a three weeks holiday so that the children can pick potatoes. This school was at\nCross River, there were 25 children from Grades 1 to 10. The school was not clean,\nthere was no running water and as we wanted to wash our hands before lunch it was\nnecessary for the children to go to a neighbors to get some water. No towels, no soap.\nThere were two rows of double seats. The teacher had not sorted out the children and\nbig ones were sitting with little ones. However, this did not make so much difference\nbecause all the seats were the same size and fourteen of the twenty-five children were |\nnot able to reach the floor with their feet when they were sitting. Miss Wheeler spoke\nabout this and asked if they would get their fathers to make foot stools for them. This ,|\nschool had not been visited by the nurse for examination other than immunization since\n1943# M<\u00C2\u00AB\u00C2\u00AB\u00C2\u00BBwhMi\u00C2\u00AB>\u00C2\u00BBi\u00C2\u00BB\u00E2\u0080\u0094lIhbkiw\"fc\"\u00C2\u00BB\u00C2\u00BB \u00E2\u0080\u0094 tBfcuthwjmhildraw First of all, Miss Wheeler\nwent 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\nunder-weight. Following this she tested the vision with the Snellon chart. The vision\n -70-\ntesting took exactly 45 minutes. Two children were found with defects. One of these\nthe teacher knew about and the child was getting glasses at the end of the week. The\nsecond child had no obvious symptoms and was able to see the board quite well. The\ndefect was only slight and it was not felt that it was necessary to even refer it. Of\n^LTw6 1WS aU this TOrk? By this time it was noon and as the women of the\ndistrict were coming to clean up the school in the afternoon, it was impossible for\nMiss Wheeler to return. On her return she would no doubt, complete the inspection and\nmake out her report* I am sure she would also talk with these children about certain\nobvious health situations*\nWhile in the school I asked the teacher for the course of study in health.\nShe had to do considerable amount of searching before she found a rather tattered\ncourse of study. The health curriculum occupied about two and one-half pages and is\nas lacking in lie tail as the Nova Scotia curriculum is full of it*\nMiss Wheeler and I went over to a beach near Malprfque for lunch. We discuss-1\ned the whole program then. She feels very definitely that it is much more important te.'\nget into the homes and visit the infants and pre-schools than it is to do the routine\nschool work. She said that in Wellington, the doctor there has about 400/58nifl8ements\nyearly. She cannot begin to see even the smallest proportion of the new babies. I\nbelieve that birth lists are sent out from the Charlottetown office. She has not made\nany effort to get names from Summerside hospital. However, I believe that cooperation\nwith the matron there is most difficult. Miss Wheeler feels that the school program\nis given too much emphasis. The Immunization prgram which is carried on every three\nyears causes a considerable interruption and the rest of the program, such as T.B.\nvisiting, if any, and the baby clinics must be interrupted for this*\nMiss Wheeler does her rural schools when travelling conditions make it\npossible and spends the remaining months in the work in Summerside. There she has\n800 children in what is termed the \"high school\" but is actually an elementary school\nwith grades 1 to 10, and 500 in the convent. Her program is to inspect, with the\nmother present, all grade I children. Miss Wheeler is the only nurse who has made any\neffort to have mothers present during the inspection. She also inspects the other grad\nes, but does not weigh and measure them consistently. She stated, when weighing the\nchildren in Cross River school, that she did not usually weigh the children in the\nrural schools. However, it was one method of establishing relationship with the\nchildren. She was not going in and immediately examing them for defects. There is\nsome poitt to this, although I do believe more and more, that this is the teacher's\nfunction and the nurse goes in and acts as a consultant. That there is another wa/\u00C2\u00A3y\nthat she can establish the necessary relationship with the children. Miss Wheeler\nstates that pediculosis is quite a problem, there is also quite a lot of scabies and\nimpetigo. Immunization in Summerside is done eaeh spring or else the children go to\ntheir family doctor* There is a charge of 25tf for the three dorses and 10\u00C2\u00A3 for the\nreinforcing dose. The doctor gets remuneration by the hour and mileage if he uses his \u00E2\u0080\u00A2\nown car. They start immunization at six months and give a booster dose every year.\nIn relation to immunization, if the parent brings the child, this is considered as a\nconsent. In the town schools where the teacher does not know the parents, consent\nslips are signed. But if in the country, and the teacher knows the parents, they do\nnot bother with a consent slip.\nIn relation to communicable disease, they do not seem to do anything. The\nlocal doctor reports and placards*\nPre-natal work is only incidental*\nUp until recently V.D.* has been a specialized program, but now the nurses\nare carrying it in their generalized work.\nOn our first day in P.E.I. Dr. Baillie and I went to Summerside and talked\nwith Miss wheeler at her baby clinic there. She has a very nice set-up for it,\n -71-\n^^^T^i7 t^7 tW\u00C2\u00B0 baMeS Were Present. The streets were lined with cars.\nILT^ 5\u00C2\u00A3t HP ? ^0mpauJ thiS With the sit\u00C2\u00ABation in Baedec. There is no doubt\n?\u00E2\u0084\u00A2\f\ 3 relationship established in doing the pre-natal work is a very\nimportant one and very helpful in the follow up*\nIn Charlottetown, Miss Ross carries the school program. Miss Ross had a\nrefresher course with Kellogg a year or so ago and she has been trying to incorporate\nsome of the ideas into the school program here. I do not know if she has met with\nvery much success. Copies of her material are contained in the files. Miss Beer\ncarries two of the Charlottetown schools and also has a baby clinic in Charlottetown*\nMiss Ross goes to the baby clinic only occasionally. They are very busy, there is\nvery little follow-up work done in infant welfare. The greatest proportion of the\ntime is spent in the school program.\nPrince Edward Island Hospital -* Charlotte town. ,\nThe P.E.I. hospital has 200 beds. There are about 65 students. Miss (Hair *j\nis the superintendent of the hospital and Mrs. MacDonald is the Director of Nursing,\nThey have 13 so-mailed, head nurses. There are no actual general duty nurses as such* ,\nThe work is done by the students. The registered nurses having charge of the fleers.\nThere is considerable confusion in the educational qualifications in P.E.I.\nPrince of Wales College situated in Charlottetown, at the end of two years they have\nattained grade U and receive a junior matriculation certificate. But grade 11 from\nMontague, Summerside etc., is not equivalent to the grade 11 from Prince of Wales,\nIt is equivalent to about a 10J- from Prince of Wales, as that is what one year at\nthat college is called and it is considered that 10J- from Prince of Wales is better\nthan grade U from the other schools. Grade 11 from the other schools gives entrance\nto the junior Maritime colleges. An examination is written which is prepared by the\nMaritime 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\nfor a student at Prince of Wales to take the two years in one and get the same stand- \u00C2\u00BB\ning. Apparently the schools of nursing wish to take the grade 11 students from Prince\nof Wales but they will also take students from grade 11 from the other schools. This\nwill not qualify them to take a post graduate course in any of our university schools.\nIn the legistered Nurses Act for P.E.I, there is no grade specified. In the P.E.I,\nhospital they have the class filled for September and have some lined up for next\nMarch's classes. Last spring was the only time when they had difficulty in getting\napplicants and this year they have more than last. They stated that Summerside has\ngreat difficulty in obtaining students. (Mrs. MacDonald is also president of the L\nR.N.A. in P.E.I.Qnd I discussed general nursing with her and with Miss fNair),\nP.E.I, hospital had 18 graduates last year. Of this number only one is left\nin the hospital. 15 have gone to other provinces, one has gone to U.S.A, and one got ?\nmarried. They do not feel that it is salary or working conditions which causes this\nexodus. The girls just want to see Canada, They take \"The Canadian Nurse\" and they\napply for positions before they are finished. The salary for the graduate nurse is\nfrom $110 to $115 a month with full maintenance. The night supervisor receives $160\na month plus full maintenance. They work 8 hours on a broken shift. They are off\nevery second week-end, Saturday afternoon and Sunday and during the next week, they\nhave one whole day off and work Sunday. $25.00 is the allowance for maintenance as \u00C2\u00BB,\nfar as income tax exceptions are concerned. They have four weeks holiday with pay and\neighteen days sick leave, if required. No practical nurses are used and no nursing\naides. They have ward maids who do the dusting and sweeping. J\nMiss McNutt who has just recently graduated from McGill in Public Health,\nhas been employed by the P.E.I, hospital since the first of Jugst. She wJl be.doing\ngeneral duty work on the floor and will look after the health program for the stude ,\n -72-\ntt ?n^o3!if h6alth S?Ca.i0? Snd ^ also taach some bacteriology. They would like .\nS\u00C2\u00A3j\u00C2\u00A3iSrJE ST P^4 \u00C2\u00BB6^ affiliation, but I did not feel that there was much\nenthusiasm for this. Miss McNutt will get $125 a month with maintenance, this is much\nbetter than toe salary of the public health nurses with the health department. Apparent\nly Miss McNutt prefers to work in the hospital, the salary did not enter into the consid\neration when taking this position. She is, however, very interested in V.O.N, work and\nif a V.O.N, service is established in Charlottetown, will probably want to transfer to\nal.\nThere is no referral to the public health department of any cases from hospit-\nThere is no affiliation for tuberculosis. ' |\nPtBtIt Sanatorium - The sanatorium has 140 beds. In addition to the matron there are\n11 registered nurses. There are 14 trained attendants. 9 of these graduated from the ,\nSan. last year, the other 5 are students. The trained attendants get from $70 to $80 i,\na month, plus full maintenance. The student attendants receive from $35 to $45 a month,\nplus maintenance. The course for the trained attendants is two years. At the end of >::.\nwhich time there is a graduation ceremony with pins presented. Miss McClellari^ admits\nthat it does not take two years to train these poeple but it is one way they have of\nholding them. She feels they do very effective work. At the present time they give\nhypos and even streptomycin, although she admits that this is not desirable. They do\nthe housekeeping as well as the bedside care. Miss McClelland^feels that the ordinary\nregistered nurse will not do a teaching program anyway and that by using trained\nattendants, the teaching program is not necessarily suffering. The lack of affiliation\nfor 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.\nShe states that her graduate nurses who are in charge of floors, will very frequently,\ndo bedside care themselves. It seems that she has great difficulty in getting it over\nto them that that is not their job.\nMiss McClelland, says that the nurses want a broken shift. On Sunday they have\n9 - 3 or an A.M. or a P.M., and in addition have one day a week off at 10 o'clock.\nEvery third week they get a ten off on Saturday and have all day Sunday. The nurses\nget $105 a month plus maintenance. Miss McClellariii, said that in discussing the nursing\nproblem in Sanatoria with other San. matrons, who were at the C.N .A., it seemed to be\nquite general that the nurses preferred to work in a broken shift,\nErince County Hospital. Summerside - Mrs, Boehner, matron. Ihis is a sixty bed hospital\nand Mrs, Bodhner says there are eighty patients, approximately and in addition, about\ntwenty beds for newborn babies and sick babies. I hoticed on the maternity floor that .\nthere 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\nis in charge of the floor and her assistant is called the head nurse. There are twenty-\nfive to thirty students. Mrs. Boehner would not admit that they are having difficulty\nin obtaining students. The majority they take are from grade 11 in schools outside of\nPrince of Wales. Graduate nurses start at $90 a month and are raised after the first I\nyear to $100. The supervisor starts at $110 or rather $120 and the head nurse at $110.\nThey work six days a week and prefer the bpnken shift, they have amonths holidays.\nThere is one nurse aide on the staff and ward maids, they are not using practical nurses,\nThey do use a practical nurse as a special only. There is no affiliation for the r\nstudents in Communicable Disease, Psychiatry or Public Health. Mrs. Bodhner is looking\nfor someone who would be qualified to be a director of nursing for the school. She says\nshe has an instructor, a nurse who has not had any special training in teaching or\nsupervision, but who was a former school teacher.\nJ\n -73-\ny^Sl^y \" A*U?dTl *\u00E2\u0080\u00A2 ^thly clinic at Summerside. Dr. Creelraan examined the Patients who are brought in by appointment and fluoroscope. X-raying is dona\nS?.J^\u00C2\u00B0?S 5^ **\u00C2\u00A3** rl9 tW\u00C2\u00B0 nUrSes present at the <*****\u00E2\u0080\u00A2 *is* feeler, whose\ndistrict itisand Miss Tate who does the special T.B. work. At the clinic the duties\nseemed to be divided as follows - Miss Wheeler, met the patient, weighed them and had\nthem undress in the cubicle, pulled the files and took new history whan necessary and\nattached a sheet to the records, putting on the name, age, and weight. Miss Tate,\ncompleted the notes for the doctor on the attached sheet. She sat in with the doctor\nin his room. She later went with the doctor to the hospital, where x-ray films were\nread and took notes for him.\nThese records are then taken back to Charlottetown for typing and the records\nare returned to Summerside at the next clinic. Miss Wheeler, therefore, does not get\nthe information before this. She cited examples where this is very inconvenient.\nThere was one new case, a child. The mother stopped Miss Wheeler on the road and\ntalked with her about the case. This was the first she knew about it. In another case\nshe went into the home and found a very ill baby. This was later diagnosed as tubercul\nosis. Miss Wheeler was not upstairs there was a man with an open case of tuberculosis,!\nIt seemed to me that Miss Tate is merely being a clerical worker for the\ndoctor in this clinic,\npRecomendations\n1. That there be a more completely generalized service, the nurses doing the T.B.\n\u00C2\u00A3ollow-up in the home.\n2. The reports go to the nurses at the same time they go out to the doctor or the\npatient,\n3. That Miss Wheeler attend the clinics in her area and that other nurses attend the\nclinics in their respective areas.\n4. A part time clerk be engaged in the Summerside office. She would be for Miss\nWheeler and would take the notes at the clinic, and also could go over to the hospital\nand take the notes there. She would then complete the records right in Summerside.\n5. Miss Tate would not attend these outside clinics when the district nurses did.\n6. That there be a medical social worker on the Sanatorium staff for the welfare work.\nSaw Miss Tate in the Charlottetown office. She went over the books that she\nhas to keep for the annual reports for Ottawa and for the San., also the monthly report\nfor the Welfare. There are four books with the names of all the patients (out) are\nlisted. In some places they have the diagnosis, the municipality responsible, the\nexaminations, mobile unit etc. This is purely clerical work. Miss Tate states that\nshe spends one-quarter of her time on clerical work, one-quarter on welfare, one-\nquarter on clinic and home visits, and one-quarter on travel and miscellaneous.\nVenereal Disease - Miss Cox, until May of this year was employed as the special nurse\nto do venereal disease work. In addition^ to taking her public health nursing course\nshe took the special three months refresher course at McGill in venereal disease \u00C2\u00A3\nnursing. However, the last year or so, the number of cases has fallen off so greatly\nthat there was very little for her to do and she became very fed-up with the work and\nso was transferred to generalized service. She still is a channel through whieh the\neases are referred to the nurses in the district. She attends the Summerside clinic\nonce a month and sees the new cases. Miss Cox completed a very nice Job analysis form\nand has stated her ideas there. She feels very definitely that nurses need social\nJl\n -74-\nSTmeScaf sSal ^^\"^Ji\"6*86 W\u00C2\u00B0rk \u00C2\u00AB a ^eat deal of ** c<\"*d * done by\n^se^buf t^r^nte a LV^,rdinary \u00C2\u00B0aSe wa,ta out TOy v*11 \u00C2\u00BBith the public health\nnurse, but the minute a difficult one comes along then all the skills in interviewing\nthat are available are needed. It i<* th\u00C2\u00ABn +>,\u00C2\u00AB+ +v,\u00C2\u00AB JZZ u -.fu m interviewing\n-gs * \"u ^\"O11 that the public health nurse feels at a great\nj^1^ R^ Cros8t PI?tIf Mvi\"1fla - Miss Arsenault is the Commissioner here. Miss\nDarrach is the nurse whose chief duties are in relation to the crippled children program.\nThere is also a nutritionist, Miss Haines and two or three other workers. The Red Cross\nbranch here is very active.\nThe Crippled children's work is quite extensive. Dr. Acker comes over from\nHalifax about three or four times a year. He sees all cases referred for examination.\nSometimes he may do the work in the P.E.I. Hospital and sometimes they may be taken over\nto the mainland for surgery. There is no orthopaedic specialist in P.E.I. At the preset\ntime the Red Cross have 250 cases on their records. These may be referred by the doctor,\nthe public health nurse or by the parents. They also have a part-time physio-therapist,\nshe holds corrective clinics at Charlottetown three times a week and in Summerside, every\nother week. There are sixty children now reporting at these clinics. Last year, the *\nRed Cross sent $12,000 for orthopaedic and also for the supplying of glasses and tonsill- |\nostomies for needy children. Any child in P.E.I, who needs glasses and cannot afford to\nget them can get them through the Red Cross, and any child needing a tonsilectomy can\nhave this done. The doctor contributes his services and the Red Cross pay the hospital.\nMiss Haines, the nutritionist, has been working on a school lunch program. She\nhas had good results in fifteen schools and recently has learned of ten other schools\nwho have a hot lunch program. It is really a supplement to the noon meal. She is also\navailable as a consultant, but not has not been used very much by the Health Dept. I fear, \u00E2\u0096\u00A0\nIn 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\nnow four loan cupboards, one in Charlottetown, one in Summerside, one in Hunter River and\nen Pine Valley. With the exception of the one in Summerside, these are looked after by i\nvolunteer workers. There seems to be a very great demand for the material which is\navailable on loan through these loan cupboards. Miss Garrett feels also that there is a\ngreat need for bedside nursing service.\nIn relation to follow up visits on the crippled children, Miss Garrett herself\nseems to do this. There does not seem to be a referral back to the public health dept.\nDr. Shaw. Superintendent of Education - Dr. Shaw explained the Grade X and Grade XI\nschooling at Prince of Wales and in the other high schools on the Island, It is very\nconfusing. Previously to last year there was no full year of professional work for\nteacher training. This has now been instituted. Pupils who come in to Prince of Wales i\nhave had Grades 1 to X in rural schools. The first year at Prince of Wales is not the\nequivalent of Grade XI, it is really X plus or 10J- as it is sometimes referred to. The\nsecond year gives them Grade XI standing, which is junior matriculation. This will\nenable them to enter any university in the Maritimes and also any other university in\nCanada. It is almost equivalent to Grade XII which is required for other universities\nbut they are accepted anyway. It is also possible for a student so desiring, who has\n$5% or over when they enter, to take the two years in one and thus write a special\nmatriculation examination. In the other high schools on the Island, the students take\nonly oneyyear beyond the Grade X which is taken in all the public schools. They write\nthe maritime entrance examination, then are eligible to enter the universities in the\nmaritime provinces. They are really very weak students on the whole because it is very\ndifficult to give the background of Grade IX and X ten subjects in the rural schools.\nIn relation to teachers training, those who come to Prince of Wales, take the .\nfirst year, the second year would be a straight academic year which they take Grade XL\n -75-\n^SSor^^secoi/v ^IZ 3eC\u00C2\u00B0nd 7ear \"\u00E2\u0096\u00A0* ** th\u00C2\u00B0 teacher training year. On\nSfrJirst c?asr\u00C2\u00ABL\u00C2\u00AB^ V*\u00C2\u00A3 th&7 r8Ceive a 3econd class certificate. In order to\nft P^in^ of \u00C2\u00A31L l^flZ** ^ mUSt hSVe a fuU matriculation, that is two years\nat Prince of Wales, and then, the year of teacher training*\noww J w^! Ml,apd *sland ^^as one hundred or raore new teachers each year in\nE2ML S^ vacancias and meet the needs of expansion. The last few yeaJs they\nhave been training only fifty or sixty and now nn* need raore than double that\nnumber*\nn a rr 4 ^f*1***011, *\u00C2\u00B0 e?trance for schools of nursing - the girls who have taken\nGrade Hin the schools outside of Prince of Wales are eligible to enter schools of\nIT8???,^ ^J1*?6 ^ard Island and may become registered* They would not, however,\nbe eligible to take post graduate course outside of the mVtritimes* The nurse who\nhas had her full Prince of Wales would be eligible would be enter a university outside\nthe a\aritimes. Dr. Shaw feels that we are right in requesting a higher standard for\nnurses but he states that universities are traditionally slow in changing their\nentrance qualifications and feels that perhaps there are some subjects which could take,\nwhich would be of more value to them, but which are not yet acceptable as qualifying\n'them for entrance to the university*\n -76-\nSetpember 16 and 17th. 19^8 - Victoria\nOn the afternoon of the 16th met with Miss Frith. Both Dr. Amyot and Dr.\nTaylor were away. Completed key information form.\nOn the morning of the 17th met with Dr. Amyot and Dr. Taylor and Miss Frith.\nThere was no Consultant Committee formed in this province. At the meeting with the\ngroup, they stated that there greatest problem was lack of personnel, especially doctors.\nThe great need was to develop health units and this was being hampered by the lack of\n\u00C2\u00AB ^JJ'!011?81^ ?!? is n0t nearly as great a shortage of nurses in this province.\nMiss Frith feels that if she had ten more nurses she would carry on very nieely at the\npresent time. Plans for the future include two teaching centre units for all personnel,\nplus a number of others for nurses. Dr. Amyot feels that the public health course in\nBritish Columbia should turn out a minimum of 80 public health nurses for the next five\nyears to meet the need and expansion in British Columbia. This year they only obtained\nfour from a graduating class of thirty-five. Apparently a great many went to the U.S.\nWe heard quite a long discourse on the advantages of a uniform for public\nhealth nurses. Apparently all the nurses like it very much and there has been no\ndifficulty in getting them to wear it.\nIt was arranged that we would go to the Central Vancouver Island Health Unit,\nwith headquarters at Nanaimo for the next week, and that after a week in Vancouver we\nmight make a call on the doctor in the North Okanagan Health Unit.\nCentral Vancouver Island Health Unit\nWe were in this unit from Monday noon to Friday noon,\nthe following -\nMonday afternoon spent with Miss Priestly in the office*\nMy observation included\nTuesday, in the morning we went to Duncan and I went out with Miss Morrison, the nurse\nthere* 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,\nOn Wednesday we all went to Port Alberni, there I want out with Miss Beattie who has\nrecently been transferred from Armstrong,\nThursday I went out with Miss Dangerfield in the Nanaimo area and in the afternoon saw\nthe child health conference in Nanaimo,\nFriday morning returned to the office to clear up the remaining points with Miss Priestly\nFriday afternoon, returned to Vancouver,\nThere are eight districts in this Health Unit. In all there are eleven nurses\nand 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\nDistricts especially. The service was organized along a bedside nursing idea, and very\nfrequently the older members of the community will harp back to tikis and want an lncreas-,\ned bedside nursing program. They, however, are never able to show a definite need for\nit. Miss Priestly believes that the need is more for a visiting housekeeper service.\nWhen the hospital insurance program is introduced and the chronic cases are discharged 1\nfrom hospital, as is stated is going to be done, there may be a need for an increased\nbfdside nursing program. At the present time the nurses give a demonstration program\nalthough there are very few cases done* If there is this need, it is anticipated that\nthe Health Unit will take the load until they find out exactly what it is going to\nmean. Rather than bring in a V.O.N, service they would prefer to add registered nurseiB\n -77-\n^J^^rLn^883 *! Sf8ir 8^f- ^^ *\"*\u00E2\u0080\u00A2 has been an agitation for V.O.M.\nST^tJSi!^11 2* \"^ *obertson has been over talking to the people. They do not\nknow exactly where they stand at the moment.\nfuxilaries - Miss Priestly has organized auxilaries in some of the various districts.\nThere is one going in Nanaimo and one in Duncan at least and I believe, one in Port\nAlberni. These seem a very useful adjunct to the health unit nursing staff. The\nnurses attend all the meetings and arrange an educational program for them, they also\nhave outside speakers. As a general rule the members of the auxilary represent sorae\norganization in the community and therefore report back. This an excellent means of\nlay education. There is a union Board of Health and as yet,the auxilaries are not\nrepresented. Miss Priestly hopes that each auxilary will be able to send one representative to this Board. The Board meets every three months.\nManuals \u00E2\u0080\u00A2 the manuals are prepared from the provincial office. There is really no\ngeneral policy manual on public health nursing as yet but there is a reference manual\nwhich includes many of the policies which have been sent out from time to time.\nSchool program - This area last year spent most of its time, as far as the school\nprogram was concerned, on the Wetzel Grid, They disregarded all former routine and\nconcentrated on the Grid, Children were weighed and measured by the nurse. Apparently\nbefore last year, the weighing and measuring had been left to the teachers and when\nthey came to plot the Wetzel Grid they found that the weights were very far out in many\ncases. They have, therefore, concluded, that the teachers cannot be trusted to weigh\nand measure the children. However, I do not think that this stands. The teachers, if\nimpressed 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\nWetzel Grid, it was the policy in most of the areas in the province for the doctors to\nexamine Grades 1, 4> 7 and 10, and the nurses to inspect all other children. They had\nbeen cutting down on routine class room inspection. Miss Priestly says they do not do\nany of that now. However, when I went out with two of the nurses, they both mentioned\nthat sometimes they did a routine inspection. In going out with Miss Dangerfield in\nNanaimo, I noticed that her routine was to call at the schools and visit all the rooms.\nShe makes a visit to the school once weekly. She would ask the teacher if there was\nanything she had to report. Sometimes there was and sometimes there was'nt. The\nteachers apparently were quite aware of those with eye difficulties. In one of the\nclass rooms a little boy, when the nurse was there or just as the nurse was leaving,\nstated that he did not feel well. The teacher did not refer him to the nurse, she took\nhim back to the cloak room and sent him home. This may or may not have been the right g\nprocedure. It was, however, rather interesting. Miss Dangerfield announced to the\nteachers that next week she would be back to do the weighing and measuring of the\nunsatisfactory cases, since she thought that they were going to continue with the Wetze!(\nGrid, at least for the Grade l's and the unsatisfactories. This program has not been\ndefinitely decided as yet and so there routine of school work is rattier in abeyance.\nOn my visit with Miss Beattie in Port Alberni she did a routine inspection oi\nthe classroom and found two skin conditions, one scabies, and one impetigo. On our\nreturn to the office we discussed the importance of this. Miss Priestly insists that .\nthe nurses do not do class room inspection and the argument was - how important was it\nanyway to find these two cases. There seemed to be general agreement that it would\nnot have made much difference if they had been missed and the teacher had not referred \u00C2\u00BB\nthem. The teacher was the one who should have been alert and referred them to the e\nnurse. However, I do not think that Miss Beattie has impressed this upon her teachers, 1\neither in her former area, or that she will in this without sorae guidance. She is one I\nwho had been following routine. She stated to me that she thinks back to what she saw\nin her field work practice, this was in Ontario, and that is what she tries to follow\nout in her area here. No doubt Miss Priestly will give her better guidance.\nSchool.\nIn Nanaimo in my visit with Miss Dangerfield, we went to the North Ward\nThere is one very ancient school of four rooms. It is so old that there are\n -78-\n^/Z/00^^ ^ lavatories* How^ar, she is hoping that this will be corrected\n* J t+ t?o k t Same gr\u00C2\u00B0Unds *ere is a very modarn school which has just been\n2f?\J ^ u fOUr TOT' excella^ lighting and excellent facilities, running\nwater, etc., in each room. The children and teachers are all delighted, and as one\nteacher said, it gives quite a lift,\nJ4 ^ *\u00C2\u00A3 the records of the class are kept in the unit office in their books which\nare distinctine of the British Columbia provincial service. This means that as far as\nschools are concerned, the teacher makes out a list of the children and thenurse takes\nthis to the office and either sorts the records herself and gets them in order, or gets\nthe clerk do it, I rather suspect that the nurse does it herself. This means a consider* \\nable amount of work. It means also that the teacher does not have any record at the \" . j\nschool. The nurses are supposed when they visit a school to take the records along with i\nthem. However, they do not cart the heavy books as a general practice.\nMr. Alfair, the principal in Duncan mentions the fact that the teachers had no\nrecords at the school. They have the progress records and he found that the teachers\nwere not using them so developed a system whereby the records were kept along with other\nmaterial in each class room. It would seem that there should be some space on these i,l\nrecords for \"health information so that the teacher has something in addition to the\nprogress and the intelligence of the child. The high school program is a somewhat modi- |.\nfied elementary school program. Nurses call regularly and immunization program is also\ncarried out. I dot believe believe th\u00C2\u00A3 nurses are used very much for counselling. In\nthe school program, the nurse does seem to approach more the consultant idea. I noticed\nthat Miss Dangerfield checked on posters for the teachers and said that she would bring\nthem along. This type of health service seems to be a much better one than the routine\nwork which is carried on in some places.\nThe child health centres are quite well developed. I notice they have not yet\ngiven up the title \"Well baby clinic\". In some of the very small areas they may be held\nin private homes. If the nurse can gather together ten mothers she feels that it is much\nbetter 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\nweekly, and they visit every case. They apparently, are able to do this. Also a birth\nlist is sent from the Victoria office every week. As a rule, however, the nurses have\nvisited previous to this. There are not many requests for demonstration baths. In\nsome of the child health centres they use volunteers and in others not, depending on the\nsize. The routine is very much the same as ln all child health centres. One nurse does\nthe immunization in the larger ones, in the smaller ones, each nurse does her own if there\nis More than one nurse. In their conferences the majority of questions the mothers ask\nare in relation to diet. The nurses will add to the diet and they might add to the\nformula. They would not change it unless they feel the mother would not go to the doctor,\nI do have a feeling however, that perhaps the family doctor is not considered as much as\nhe should be. For example, when visiting I noticed that Miss Beattie arranged with the\nmother 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\nfeel however, in this case that it would have been profitable for the mother to come out\nto the clinic or even to her doctor. In this case there was no mention of her even\nasking the doctor about immunization.\nIn the small clinic which I observed in Ladysmith the nurse did not have it\narranged too well for conferencing. For example, the mother was standing. Her literature\nwas over on another table, this consisted of the provincial and federal literature. In i|\nthe Nanaimo clinic there was no literature of any kind. However, all the mothers have\nhad \"Canadian Mother and Child\" and they have also been receiving the infant and preschool letters monthly from Victoria.\nThere is no set policy in relation to follow-up visits, that is the frequency\nof visits to infants and pre-schools. I think that if the baby is being brought to\naM\n -79-\n^fthho^4e^re thSre *! nv follo,\u00E2\u0084\u00A2P *\u00C2\u00BB the home. They would however, follow-up\n^2^\?J5 there seems to be a need. Miss Priestly feels that the pre-school\nprogram is not wall developed. It, as is usual in raost places, seems to be that in\nbetween period when there is not much done. Miss Priestly would like to get study\ngroups going for the pre-school group*\nPre-Natal - There are very few pre-natal cases refered by the doctor. There does not\nseem to have been very much done to try to impress the doctors with the contribution\ndhlch the public health nurse can make to the pre-natal program. Hiss Priestly feels\nthat if the nursing group would list their contribution and would try to sell this to\nthe doctors as a service they can use, as they have used other services. She, however, -\nhas not yet convinced the M.O.H. of this procedure. There seems to be here, as In other ]\nplaces, a reticence on the part of the M.O.H. in educating the private practitioners\nin the community. Miss Priestly feels that the particular contribution which the nurse\ncan make is because she has the time, she can -\n1* Show the mother, through visual aid what the whole pregnancy means.\n2. She can prepare the mother for breast feeding. $\u00E2\u0096\u00A0-\u00E2\u0096\u00A0 I\n3. She can prepare the mother for the care of the infant. i\n4. She can help prepare the other members of the family for the reception of the baby.\nThere are probably many other things which ate if a group got down and worked on it\ncould be worked out as the contribution of the nurse, I think that this is a very great\nneed at the present time in the pre-natal program, because it does definitely seem to\nbe one of the weaknesses.\nTuberculosis - I visited with Miss Dangerfield one case of tuberculosis. Apparently\ntuberculosis is not too great a problem. Most of their cases are hospitalized and there\nare a very few waiting. Miss Dangerfield says very definitely they are much better\npatients after they return from sanatoria, as they learn there the meaning of rest\nespecially. They teach the patient isolation, precaution for all active cases.\nVenereal Disease control - de nurses do a case holding and a case finding program.\nSince there is an Epidemiologist who will visit on need and a well organized staff\neducation program, the nurses do not seem to feel so lost ln doing a venereal disease\nprogram as they have in many places. The answer seems to be staff education.\nStaff Education - This carried on through a monthly staff meeting. This lasts for about\nfour hours and at this meeting matters concerning policy and administration are those\nchiefly discussed. Then there are the stu$y groups which also meet once a month.\nUsually on a Saturday from 11 to 1. Each group decides on a project and when the\nproject is completed it is frquently sent to Victoria where it may be printed and\ndistributed throughout the province if accepted. Tais adds an incentive to the nurses, \\nThere is a North Island study group and a South Island study group. Miss Fiate? told\nme in relation to the study groups that every nurse in the province is attached to one.\nThis involves a considerable amount of travel time on the part of some but I believe\nit is considered well worth while.\nThe following is a copy of the memo which the M.O.H. has written for the nurses in\nregard to immunization -\n\u00E2\u0080\u00A2This grants authority to you to perform immunization procedures, including smallpox\nvaccination from this date until further notice\".\nMiss Priestly has designed a box to carry the child health centre equipment\nfor those child health centres which are set up each dav and may be held in the\n -80-\nirholL^hr^JL18 l^en SUit Case made *\u00C2\u00B0 order' Parted black on the outside.\n2r lit J\u00C2\u00A3 il^ld lfCh are \u00C2\u00ABollapslble, the plastic cover, the turkish towelling\nillJSt Pif JSTi!??un ?*?rilijser or P^, and has a pocket'for literature and\nlilt\u00E2\u0084\u00A2 iJi\E; chiid+health centres the nurses are supposed to wear their white\naprons over their skirt and blouse. It was noticed in the Nanaimo clinic that they\nwere wearing their complete uniform and no apron.\nSupplies are not sterilized for the immunization, only the needles and syrin- '\nges. For inoculations they cleanse the arm with Zephryn, 1%. For vaccination they\nuse green soap and then acetone. For the patch test they use acetone.\nIt was stated many times how much the parents appreciate the mothers advisory ;\nletters. They are very pleased to have them also come on the day of the babies monthly i\nbirthday. 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\nthe use of these letters. They are sent out by the clerks and are not of' any work for\nthe nurses.\nIn relation to the welfare program, where the services are developed as they I\nare in British Columbia, the problems of the nurse are much less. For example -\ncompare British Columbia with Nova Scotia, where it was stated that one-half to one-Mdb \u00E2\u0080\u00A2\nthird of the spent on tuberculosis was spent on a welfare program by their problems.\nAll the nurses in this unit are graduates from the U.B.C. course, except\nMiss Beattie who took the course in Toronto some two year*ago. There was also a new\nnurse who arrived the day we left, she had just completed her course at McGill, the\ndegree course and was from Regina. She said that she had written to the employment\nservice in Edmonton but that she had received no reply. Knowing that they are short\nof nurses in Alberta, this seems rather strange.\nVANCOUVER\nWe spent the week of September 28th in Vancouver visiting the following - Metropolitan,\nT.B., V.D., Placement Service,Registered Nurses Association and U.B.C, also V.O.N.\nand the Normal School.\nMetropolitan Health Committee - The first day in Vancouver we had a meeting in the\nafternoon with Dr. Murray, Dr. Pallen, Dr. Willett, Miss Hunter, and for a part of the\ntime Dr. Gundry. We discussed the various problems and procedures in relation to\npublic health. Dr. Murray and Dr. Willett were very gullible. Dr. Murray was more on\nthe defensive than I have ever seen him. There was considerable discussion of the\nschool program and routine physicals. Dr. Murray thinks that these are important.\nOne of their greatest difficulties is shortage of medical personnel. Some\nof the reasons for this are stated that the program is too routine. They have no\nimagination to see what they can get out of it, low salaries, and not enough presitfee (\nfor this type of public health work.\nIn relation to dental staff, Dr. Pallen says there is a shortage, the reason\nbeing low salaries and that many dentists dislike children's work. Also in relation to\nthe dental program, Dr. Pallen stated that 40 to 45* of the children go to their own\ndentist - 40 to 45^ go to the school dental clinic, and that each year fewer and fewer\nof the lower grades are going to the school dental clinic and more and more to the\nfamily dentist.\nIn relation to nursing, Miss Hunter has her vacancies all filled, although\ntwo weeks ago she did not know which way to turn. She states that nurses like to come 1\nto Metropolitan, they have heard about the program and are interested and they know\nthat there is good staff education program and good supervision and nurses want this.j\n -81- ~9Sh-\nk\u00E2\u0080\u009E\u00E2\u0084\u00A2 M hS relati\u00C2\u00B0\to general training of public health nurses, she feels that they\nhave not had enough about the normal child, or enough on mental hygiene.\n* \u00E2\u0080\u009E 4+We discllssed physical exaninations at some length. Dr. Murray feels that there\nis definite value in this but we could not get either Dr. Willett or Dr. Murray to give\nany really good answers in relation to the value of the physical.\n. * ^^ T ** the Week' met with \"i33 Hunter and Miss Henderson to complete the\nkey information form. The following is some additional information. Through the\nFederal grant they are getting extra unit clerks, hoping to have one more in each unit.\nThis new clerk will take over all the extra clerical work of the child health program\nwhich has not been done by the wolunteers. They will also do some school recording such\nas making up the immunization list, x-ray notices, etc. Where possible, this work will\nbe brougit to the unit to do. The reason they do not like to take the clerk to the\nschool is that this year, school stenographers have been made a little more available to\nthe nurses and they do not want to lose this service. The nurses also will dictate home\nvisits and home reports in relation to T.B.\nThe family welfare operate Visiting Homemaker service for their own cases, that-\nis for clients needing family case work. There is a great need for this service for T.B.\ncases. Through extra money with Metropolitan now have available, they are going to tfcy\nto work out some scheme with the Family Welfare whereby they will pay for the visiting\nhousekeepers and homemakers used for T.B. oases. At the present time, for T.B. cases\nalone there is need for ten homemakers, sixteen housekeepers and there are nine to ten\nsituations where there is need for some hourly help.\nThe co-ordination with the hospital is improving. All Paediatric cases going .\nto the O.P.D. are referred. This was started by Dr. Patterson and he now has all the\npaediatricians doing this. There is also referral from Children's Hospital and from\nstaff cases in infants.\nIn addition to the Job analysis School questionnaires, etc., Miss Hunter is\ngoing to have thirty nurses report on conferences with five mothers each. This is in\nan endeavour to get the questions asked by the mothers and to try to serve as a guide\nto 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.\nNormal School - Dr. Willet, Miss Hunter, Dr. Baillie and I discussed the Normal School\nprogram with Mi3S Maxwell, Miss Maxwell does all the health teaching, which consists\nof about twelve class room lectures and in addition there are half a dozen or so special\nlectures for the whole group together. These latter were questioned, kxfc as there seems\nto be some over-lapping, and it was felt that that time could be used better by Miss\nMaxwell. She stated that if she had that extra time she would use most of it for visual\neducation - a subject on which she seems to be a bit hipped. Miss Maxwell also has a g\nNormal School program and she carries out a demonstration service. However, in discussin\nthe work with Miss Maxwell, it was very apparent that she is not getting over to the\nteacher that they are responsible for health. She does not, or she has not, realized\nthis herself. She tells the teachers what they will do if there is no nurse, that is if \u00E2\u0080\u00A2\nthey are in a rural school and there is no nurse available readily, and \u00C2\u00B1\u00C2\u00A3xxk what they h\nwould do say, if they were in the Metropolitan area where there is a nurse. She is not I\nputting the responsibility onto the teacher. I was definitely disappointed in this part\nof the Normal school program. Miss Maxwell also has a health service for the Hormal\nSchool students. Dr. Will*t}being the doctor.\nA\n -82-\nSS^t^lf ^reI\" Di3^3ad V.O.N. program with Miss Creasor. I do not\nthink that she is altogether sold on any amalgamation with the official health agency.\nShe feels that especially in the larger cities, the voluntary effort is necessary and\nthat 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\nclasses which Miss Charters is conducting pre-natals. They have an attendance of\naround 10 to 16. Classes are operated continuously and I think there are eight lecture.\nfor each group. Miss Charters is going to list the questions which the mothers ask\nat these classes. I hope that this might be some guide to the information which nurses\nneed 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\nthe same in Vancouver as in other places, although perhaps not so acute. Doctors are\nnot referring a sufficient number of cases. Miss Creasor said that nurses come in\nfrom other areas and are impressed with the fact that mothers are going to the doctors\nin Vancouver much-earlier in their pregnancy.\nTuberculosis - Had a conference with Miss Paulson. Discussed chiefly, the teaching\nprogram on the wards. Miss Paulson gave me a complete set of the literature which\nthey have for each ward, and an outline of the teaching. The nurse in charge of the\npatient is responsible for this teaching. Through a well developed staff education\nprogram I think that the work being done here is very fine.\nIn the Vancouver Unit they have 34 ward nurses and 16 attendants or nurse\naides. In Trmnquilte there are 25 ward nurses and 40 nurse aides. This dilution is\ntoo great. The teaching program suffers, also the patients are more insecure. They\nfeel that they do not see the nurses often enough and they have a greater fear of\nsomething happening to them if the nurse is not there. The attendants wear a white\nhoover uniform and no cap. An important feature of their program is that the graduate\nnurses know how to use the attendants, they know what their duties are. This is\nextremely important in introducing this group into the hospital service. They are\ntaking only students from the practical nursing course and from the former T.V.T.\nIt is very definitely felt that the teaching in the hospital makes the public health\nnurses work easier and also makes the length of stay in the hospital less. The nurses\nlike this teaching program as long as there is time and they are not too rushed by\nother duties.\nIn the T.B. clinic there is a public halth nurse in charge and her assistant\nis also a public health nurse. Miss Paulson rightly feels that the other duties in\nthe clinic are only on the staff nurse level as there is actually little opportunity\nfor teaching. t '^Zm\nThe social service worker visits the wards on referral by the nurse to the\ndoctor. She does not visit all cases, only those referred.\nAll 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\ntook half the nurses off night duty and replaced them by aides. They have one month on I\nnight duty and one month on evening shift at a time.\nVenereal Disease Program - Conference with Miss Beattie who is the nursing supervisor\nat the V.D. Clinic. According to the new V.D. Act the local health services are i\nresponsible. Howevere, in Vancouver, because of the size of the city it is felt that '\nthere will always need to be some specialized worker. At the present time, they have\nepiddmiology workers, these are public health nurses. There is a staff of one supervisor, Miss Beattie, seven epidemiology workers in Vancouver, two epidemiology workers I\nfor the rural areas. There is also one male worker in Vancouver. In the rural areas\nthese workers act as consultants. In Vancouver they are actually carrying out the\nprogram. The Metropolitan nurses are doing a case holding program on select cases.\nJust recently, one of the Metropolitan nurses has been placed in the V.D. clinic. She\ninterviews and picks out for visiting. Cases she picks out are those where there is a|\n -83-\ndefinite address and where it is quite a straight forward case. No doubt there will be\n!!fe ^\"^a/ases referred as the program grows. The male worker is experienced in\nthe services in social case work. He is not a trained social worker. He visits the\nmarried men particularly. They try to give as much information as possible to the\nnurse in the district. They first refer by telephone and then the record is sent. The\nnurses follow up those not coming for treatment and those named as contacts. They are\nreally very selected cases. There is one social worker and she sees only those cases\nreferred to her, (See copy on file)of type of cases referred). In Victoria and the\nrural areas the public health nurses do all the visiting but there it is a smaller\nprogram. The following is a summary of the job of the epidemiology worker -\n1. (a) Interviews each new case before diagnosis\n(b) Interviews each case after diagnosis, gives an educational talk on the value of\nreporting regularly, what Is required of the patient. Contact history is taken\nalso,\n2. Each worker has patients to follow up according to diagnosis. They follow up by\nletter, phone call or visit,\n3. Visiting of contacts,\n4. Each worker is also able to relieve in the treatment clinic.\nMiss Beattie will be willing to send any information or have the nurses make\nout any job analysis, etc., which I would like in order to have supporting information.\nMy talk with her emphasized the principal that public health workers are the first\njwesrhers in this program and the social workers are used as consultants. It might be\npossible to get supporting information for this if necessary.\nIn further discussion with Miss Beattie, she said the public health nurses\ndo 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\nletter and this has to be copied off in the office.\nUniversity of British Columbia\nSpent Wednesday afternoon with Miss Mallory and Miss Morrison going over the\nquestionnaire for the Rrovisional Council Committee,\nIn relation to the merit system unit of the American Public Health Association\nthey are not able to use this at the University on account of the cost. The pre-test\nwould be two dollars and the final test probably would be three dollars.\nWe discussed the question why do nurses take public health. They felt that\nit was to get away from the hospital. There' is too much pressure there and the hours\nare longer. They also feel that the nurses find through public health, an opportunity\nto mix with community groups. This is not so easy in hospital work.\nIn relation to the nurses from the last class going to U.S.A. this seems to\nhave been quite erroneous information which was given by Dr. Amyot. They thought that ^\nonly two nurses were thinking of going and they were not sure if they had both decided j\ndefinitely. Of the class of 35, Metropolitan obtained 15. The Provincial 4 and many i\nothers returned to their former occupation in other places. II\nPlacement Service - Discussed the shortage question in British Columbia with Miss\nBraund. Since dte June the vacancies have averaged 310 to 325 per month. In 1947 the\naverage was 386 per month. Of these, the public health vacaAvies listed - Provincial\n8 to 10 public health nurses, and 3 to 4 R.BVs. V.O.N. 5 public health nurses.\nM\n shift.\n-84-\nMiss Braund feels very definitely that nurses prefer the straight eight hour\nThejmraay be some older nurses who are reluctant to give up the split shift.\nRegistered Nurses Association - Asked Miss Wright why the nurses are coming to B.C.\nShe feels very definitely that is the personnel practices which have been well advertis-'\ned in the Canadian Nurse. Another reason is climate. At least once a weak there is\nan ad. for nurses pointing out that the R.N.A., B.C. agreement is in effect. There has\nbeen an increase in the number going to the tftiited States. Miss Wright does not have '\nvery much information in the use of the assistant nurse. She does feel that in some of\nthe hospitals they are heavily loaded. The largest majority of the nurses coming in are\nfrom the prairies. The R.N.A. of B.C. have agreement with 0 hospitals and two public\nhealth nursing groups. But nearly all of the hospitals have accepted the policy.\nThey are now working on the idea of a centralized school at the University of\nBritish Columbia, They also are hoping that the preliminary class students can be\ngiven their preliminary period at the University, This would be for all hospitals.\nThe practical nurse course i\u00C2\u00A3 functioning and the is at the Technical School\nwhich will be the new Vocational School. They are taking 20 every three months. First !,\nclass will graduate in December, it is a one year course and it is hoped they will be\nplaced through the R.N.A.\nJ\n -85-\nOctober\nNORTH OKANAGAN HEALTH UNIT\n^L.1^- \" We 3t\u00C2\u00B0PPe(i off in Vernon to visit this health unit. Dr. Best is in\ncharge. There are seven nurses. Two of the nurses are situated in Vernon as well as\nthe senior nurse. There is one nurse at Armstrong and area; one in Enderby and area;\none in Salmon Arm and area and one in Revelstoke and area. The total population is\nestimated at about 35,000. There is one Sanitarian and one more to come. They have\na sub-office in Salmon Arm at which there is a clerk, as well as the clerk in the\nVernon office.\nWe discussed the program throughout the day. Dr. Best is quite young and\nvery intense about his work. In relation to the school program, they are swinging\naway fron the routine examination of grades 4, 7, 10. He is trying to do all of grade\n1 with the parent present. He seems to be making an effort to see the principals and\nexplain the program to them and gain their co-operation in doing this, Miss Denyforce\nsaid that they do not weigh and measure the children. They test the eyes every year\nand they do a physical inspection on all the children. They do not do any routine\nclass room inspection unless in a rare case of communicable disease. They usually\ndo not do it for communicable diseases.\nIn the towns of Vernon and Armstrong especially, where the former service\nwas a school service, they visiting the schools e^ery day. They are gradually trying\n^yfco get away from too much school work. Some of the rural schools are visited once\na week and others once a month. The nurses may have as many as 13 schools. The\ngreatest travelling distance for the nurse in any area is about 25 miles, except in\nRevelstoke where it is greater and the population less concentrated for the two or\nthree areas which she visits, which are more distant.\nThere are child health centres in various centres.\nannual report was obtained and this gives the listing.\nA copy of the last\nIn relation to pre-natal work, Dr. Best had contacted all the doctors. All .\nbut two have said that the public health nurse would be of value. They, however, have\nnot followed this up and not doing very much pre-natal visiting at the present time.\nThere is very little, if any, bedside nursing and hardly any demonstration work. As\na matter of fact, there is no bedside nursing. Very little demonstration bedside\nnursing and very few demonstration baths to babies. We had a very enjoyable day\nI starting out in the morning about 11 O'clock and driving down Kalamalka Lake, this\nmeans lake of many colours. We drove up the Coldstream Valley for a very short\ndistance. Then after lunch we drove to Enderby, where there is a sub-office, but it\nis not at the present time, being used because the nurse lives in Salmon Arm. Dr.\nBest is questioning whether or not an office is necessary here, especially since there\nis a clerk in Salmon Arm and as it is only 15 miles away it seems wiser to have the\nnurse use that office. I am inclined to agree with him in that point. From Enderby\nwe went to Salmon Arm where we met the statistical clerk and also Miss Stone, who\nhas just come to the provincial service after three years in V.O.N, in Vancouver. She .\nsays she likes the work very much and likes Salmon Arm much better than Vancouver.\nMiss iony&rce told me that Dr. Best did most of the V.D. work. They\nreally have very few cases, 1\nIn relation to T.B. it does not seem to be a very great problem. Each naa'jj\nnurse has very few cases to supervise, m\nm^mtmZ^yJLL I\nLeft Job analysis and.School questionnaire for Miss Donyfloroe and Miss\nWillins to collate. Miss H^^t took her public health at U.B.C. eight years ago\nand Miss Willins took hers at U.B.C. about three years ago.\ncomplete two forms.\nThey are each going to\n -86-\nCALGARY\nArrived in Calgary at noon, October 5, 1948.\nII ^ - ]+ ^ afternoon went to the City Hall and reported to Dr. Hill. This is\n^tVZu rlt^/i ^iaii^ services. Visits here included observation and conferences\nw ^ ^8n w Rreiene olinio nurses, School nurses, T.B. which is under the Kinsman Club,\nThe Child Hygiene clinics were started in 1923. Miss Laval was sent by the\nProvincial Government to organize the clinics. At that time the school nurses were all -\nunder the School Board. In 1935 they came under the Dept. of Health, but still doing\nthe specialized services.\nMiss Laval started with four centres but now they have only one at the City Hall\nThe 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\npetered out through lack of customers and other got so large they could not keep up with\nit because of insufficent staff. In any case it was out of the city at Bow Nest and the I\npeople there could not afford to finance it. The present eentre is on the third floor\nof 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\ncome in the morning- are chiefly those coming for inoculations.\nThere are three nurses in addition to Miss Laval in the Child Hygiene clinic\nprogram. All of these nurses have had public health, two of them are degree course\nnurses from the University of Alberta. (Note further on regarding observation in the\nclinic.)\nThe nurses visit the homes. Each nurse has a district. The birth registration\ncard comes from the Vital Statistics Dept. Following receipt of this, a card is sent to\nall the mothers and fcfr\u00C2\u00BBjp\u00C2\u00BBi\u00C2\u00BBntM^\u00C2\u00BB\u00C2\u00BBiiwi\u00C2\u00BB\u00C2\u00BBiLii^ii.t.Un>ni the doctor is also circularized. If the doctor returns the form saying that it is a good home, nothing further\nis done by the nurse. If the doctor states the home is poor or a fair home, the nurse\nfellows up. Most of the doctors return the letters. They try to persuade the mothers\nto come to the clinic. For those mothers that come to the clinic before the visit they\nmake one follow up initial visit. If they do not keep on coming they call again after\nthe baby is six months old regarding inoculations. This is called the follow-up visit.\nAll the birth registrations are filed in the office. At the end of six months all who\nhave not come to the clinic are circularized regarding immunization. When the child is\nbetween three and four years old, whether he has been to the clinic or not, they are\nsent 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\nchild who has been previously to the clinic. If they have never been to the clinic they\nmay not visit and they would not bother if they are living in a good part of the eity.\nEvery pre-school child gets free ear, eye and nose, and throat treatment, except hospital\nexpenses and the glasses. Every pre-school child gets free dental treatment. A dentist\nis paid by the city and gives a certain amount of time. Appointments are made by the\nnurse. When they have finished with the pre-school examinations the records are handed\nover to the school service* B\n\"The Canadian Mother and Child\" is given to those who come to the clinic.\nThey also receive a 24 hour chart and after the baby is over a year old they get the\nweight scale. The parents are very interested in this*\nThey do not use volunteers in the clinics,\n(infant goes up to the age of 2 years in Calgary).\nIn 1947 there 1,681 new infants\n -87-\n/n. took her course at McGill, 1946-47.\nDr. Weekes is a British trained doctor and has been in this area for a little over a\n-Sikr.\n^ is JT?eARed Deer He<h Unit originally consisted of five municipalities. It is\nnow divided into two, Lopom*? and Red Deer and recently the Poplar Grove area has come\nunder the municipal district. The total population is around 25,000. From Red Deer\nnorth about 20 miles, south 21 miles, the whole area is about 42 miles squase. There\nare clinic centres in sorae ten or eleven small towns. The centre at Locomfc we spent the\nwhole day which actually amounts to about two hours in the morning and two hours in the\nafternoon. The doctor goes to all the clinic centres.\nThe program seems to be largely a school and immunization program in so-callei\nChild Health Centres. The district is not divided in two for the nurses and as it is\nplanned to have a third nurse and a fourth nurse before very long, I wanted to find out\nwhat the plan would be in relation to districts. Miss Murray did not think they would\ndivide it. This shows a lack of system and supervision in nursing from the provincial\nlevel. il\nChild Health Centres - As stated above these centres are held in some ten towns. The\nafternoon of October 12th one was held in Red Deer, which I observed.' The two nurses\nwere present. The clerk took the names of the mothers as they came in and also entered\nother information in the book. The purpose was to count the attendance. From the clerk\nthe mothers went to Miss Wright who weighed the babies, they were not undressed for this.\nSome mothers she did a little conferencing with, but it was never sitting down with thera.\nThose who wanted immunization, which was the majority, went off to another room to Miss\nMurray, Miss Murray, seated while the mother was seated, gave the immunization and did !\nany conferencing which seemed indicated. This, as is usual, related mostly to diet.\nThey do not use volunteer workers in any of their centres. In some of the smaller ones\nthere is only one nurse. Some of the mothers were sent ln to the doctor. These seemed\nto be the ones that presented problems too difficult for the nurse, and also mothers who\nmight want to see the doctor themselves. The nurse would not hesitate to change a\nformula if seemed indicated. The nurses were wearing their blue dress uniforms and no\naprons were put on for the clinics. I do not think they had any aprons or bags.\nSchool Program - The doctor examines children in the school and all the children in the\nsmall schools every other year and the nurse sees thecalternate grades every other year.\nAt the beginning of the school ter\u00C2\u00A3 they draw upa p'flSe of the schools and build a time\ntable around this. This is also the way they do their immunization program and at this\ntime they wmax were conducting immunizations in the rural schools. In the winter time\nthey would do the immunization in the town schools. We estimated that about 48 public\nhealth nursing days would be spent during the year on the immunization program. All of\nthis seems a great deal of waste of the doctors time. The next morning I went with\nMiss Murray to the first two of the six schools which she was going to visit for immunization that day.\nThe first school had only eight pupils and the supervisor. All the children\nwere taking their work by correspondence. The nurse went in, set up her immunization r\nand did the children. A couple of mothers brought along the pre-school children. There\nwas no conversation with the teacher or nothing said to the pupils. The next school\nwhere there were 25 children, the procedure was repeated. Neither the teacher nor the\nnurse said very much to the mothers, of whom there were two with pre-school children.\nIn the first school about seven immunizations were given and in the second about twenty-\nfive. This contrasted very much with what Miss McClure of the Edmonton Rural Health\nunit later told me about their program. In the schools they give only the reinforcing\n -95-\ndf !L\u00E2\u0084\u00A2+^8 n^8\\u00C2\u00B0\heT ^J* wU1 give the re-inforcing dose, will do the examinations\nIL^SISSons which she is going to do for the year and will discuss any problems with\n examined\nGrade 8 first. The reason for this is so that they will avoid examinations in June.\nWhen this was mentioned to Dr. Walkom, he said that he did not know that this grade\nwas being examined first. Then Dr. Hannah examines Grade 1. He does not examihe\nthe kindergarten. In relation to vision testing, they test the vision of pre-\nklndergarten and kindergarten children as soon as possible. The reason given for doing\nthis was that two or three years ago a kindergarten pupil had a rather serious eye-\ndefect, and it was not discovered, so the kindergarten supervisor asked that *P\nkindergarten children be tested.\nMiss Eddy has another school,of about 400 attendants. She is at Kitchener\nMonday morning and all day Wednesday and all day ftriday. Part of this time she may\nbe out in the district, but I mther judge that most of it is spent in the school.\nShe is at the second school, xaxm Tuesday morning and all day Thursday, Tuesday\nafternoon is scheduled for visiting. She has a baby clinic on Monday afternoon.\nShe does a rapid Inspection in September only, and thereafter the teachers\nare supposed to send suspicious cases.\nFollowing observation in the school with Miss Eddy, I went on a home visit\nwith her. It was to a birth-registration visit. The nurses get a lis't, or Jockx\nrather, they get a record of all the birth registrations, and they make an initial\nvisit. The V.O.N, notify them of any babies which they are visiting up to the 6-weeks\nperiod, and nil overlapping is avoided so far as is possible. Miss Eddy made quite\na nice contact, the mother had had the doctor in that morning to see the baby, because\nshe felt that the baby was not getting enough from her breast. Miss Eddy left a card\nstating where the clinics were , invited the mother to the clinic, and also left\nanother card so that the mother could send for The Canadian Mother and Child,\nAnother day visited a well-baby conference of which there are, I think,\nsix.held weekly in the city. At this conference there were two nurses, neither of\nthem had had public health. However, Mrs. Martin the nurse in charge, has had\nconsiderable experience in pediatrics, and also has two children of her own. The\nclinic was kin held in the basement room of the library. It was very bright and\nlight and warm. There was no private room for conferences. The mothers brought\nthe babies in, undressed them, and brought them to the scales to be weighed. The\nsecond nurse weighed the babies, pulled the records. This was all that she did.\nThen the mothers went to Mrs. Martin for conferencing. Mrs. Martin was very\nenthusiastic about the conference method. Apparently they had not used it up\nuntil a year or so ago. All the nurses have copies of the Metropolitan Conference\nGuide, and these are liked very such. The usual literature, Federal Department,\nwas on the conference table. They do not use volunteers in any of the child health\ncentres. This is too bad, since it is very dull for the one nurse just to be weighing\nthe baby. I asked Mrs. Martin if they woi^^ke^turns. She pointed out that Miss\nJacksorf had just been with the Departa\u00C2\u00ABmir&^^ ordinarily they would take turns.\n -\n-100-\nL^+^+Lf lhe W\u00C2\u00B0?? ?0t flDd the ^i^ing ^ther dull after the conferencing and she\nadmitted that she certainly would,\n+4 \u00C2\u00BB,, A Ii5i\W^h Mr8\u00C2\u00B0 Heffel at another school did not lend much further information, Mrs. Heffel was reported as a nurse who is extremely interested in welfare\nproblems. One had a feeling in talking with her that the individual counted a great deal\nand that perhaps the general public health might be overlooked in zealousy to care for\nthe individual and see that his problems were looked after regardless of whether or not\nthe parents would take the responsibility. Mr. Coates, the psychologist came ln while\nwe were tailing with Mrs. Heffel. I had seen him previously and he had explained the set-i'\nup of the 6hild Guidance Clinic. He seemed quite enthusiastic, and he brougit out a\npoint, which I believe, is well taken, namely, that it is better to have a number of J |||\npsychologists, possibly under the supervision of a psychiatrist. That the psychologist\ncan make the approach with the teacher and examine the child first. The psychiatrist\nseems to rather xxxxx frighten people. It is probably because of the association with\npsychiatry. I think perhaps he has a good point there, in that many of the minor things\ncan be taken care of in this way and the psychiatrist's time is saved for the major\nproblems. At their Child Guidance Clinic, which is described in the key form, the\npsychiatrist 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 ,\nto the mental hygiene program and how much they are relied upon for their reports of the '\nchild and their knowledge of him and of home conditions. \u00E2\u0080\u00A2 i\nThe 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\nimmunization. There is one clinic which is held in the school on Monday afternoon. The\nimmunization nurse and Dr. Hanna attend it. The immunization nurse, although she will\ngive the immunization at the City Hall, does not give it at this clinic. The theory\nbeing that while at the City Hall, Dr. Walton is there in case of emergency and therefore i\nwhen she goes out there must be another doctor. I think it would be a great saving and\nmake a much better service if the nurses gave immunization at the well-baby clinics.\nVenereal Disease - is done by a specialized nurse, Mrs. Burns, she has not had public\nand T.B. health training either. She spends two and a half days a week at\nthe clinic which is held at the General Hospital. Practically all the tuberculosis work\nis done by the Anti-Tuberculosis League. Their follow-up from the San. is done chiefly\nby letter and through the family doctor. But if a case is delinquent in reporting for ,,JH\nexamination, they are then referred to the public health nurse or the police. Mrs. Burns\ndoes the necessary follow-up in the city of Regina, that is, she follows up the cases\nthat are delinquent.\nAll V.D. contacts are reported to her and she follows them up and gets them to\ncome in for examination. This specialized service seemed to me to be rather a waste.\nDr. Walton and Miss MacDonald feel that they need two more nurses. One to fill the\npresent budget vacancy and another would be extra. I feel however, that if they utilized\nthe present nurses to the best advantage, and cut out some of their school routines they\nwould be very well off as far as numbers are concerned. They are handicapped in that only\nMiss MacDonald and one other nurse, who is due to retire very soon, have had public health\ntraining. Z ^M \u00E2\u0080\u00A2\nDr. Walton said that they spend tan thousand dollars a year on milk for under\nweight children in the schools, I wonder if this is money wisely spent.\nVictorian Order of Nurses - There are two V.O.N, nurses in Regina. Miss Maddaford is the y;\nsenior. They have both had public health training. It is rather surprising that, in a i,\ncity the size of Regina, there are only two. They do not seem to be very busy. Miss\nMaddaford says that there are one or two nurses with the V.O.N, in Prince Albert and I\n -101- '^\nthink a couple in Saskatoon.\n/* \u00E2\u0084\u00A2 \u00C2\u00AB +^Sir T>re\"n^Al Program is very small. Up to the end of September they had only\nH FTSfS ^88kV4 ^fg^tared births up to that time were 1,175. They are seeing\nabout 22% of the babies after they come home from hospital. To date they have had 270.\nThese are seen at the request of the mother or doctor. They visit every seven to ten\ndays until six weeks, then they are advised to go to the well baby conference. In order\nto avoid over-lapping with the Health Dept. they send a list of new babies that they are\ncalling on. I do not think the V.O.N, have made much effort to contact the doctors to\nhave them refer their cases. Miss Maddaford said that 15% of their total visits are to\nchronics. They could carry a heavier case load. Their student program consists of\ntaking two students each week from the Gray Nun's Hospital, Each student has only one\nday. Not all the students will get this service. The nurses from the Rfgina General\ndo not have any public health observation or experience. Miss Maddaford says that the\nstudents who have been out with them often follow up and enquire about public health.\nThe V.O.N, also give two hours a week to industry.\nProvincial Health Department. - While in Regina I had some interesting conferences with\nMiss Smith, Director of Public Health Nursing. I was amazed to find so few of the nurses,\non the staff of the provincial department were public health trained, the vast majority\nhave not had any preparation. Miss Smith does not feel that it would be wide to set up\na course in Saskatoon. She feels that Saskatchewan cannot afford to support it and would\nbe better to send their students either to Alberta or to Manitoba. From my observations\nin Alberta, it is quite probable that they could take extra students from Saskatchewan.\nI was amazed to learn that the majority of the students in the Alberta course are degree\ncourse students. Their numbers fluctuate from 16 in 1941 to 23 in 1948. Next year they\nexpect from 15 to 16 and there iM\u00C2\u00BBttfcki\u00C2\u00AB\u00C2\u00AB*ggtn\u00C2\u00BBti;Mff are very few who come in from the\nprovincial schools of nursing. I learned more about the course in Saskatoon from Miss\nMcCann, one of the district nurses with whom I spent a day. She had graduated from the\ncourse just two years ago. She says that they take their first year in University.\nDuring that time they have History of Nursing from Miss Ellis. This is the only subject\nwhich she teaches them all the way through. Following their first year at University\nthey go into hospSal for three months, at the end of which time they are capped. Then\nanother university year and hospital for three months. When they enter at this time they\nare put in with nurses who have had much more experience in the hospital add they find\nthis rather difficult as well as embarrassing at times. At the beginning of the third\nyear at tfaiversity they attend for one-half a year and then go back to the hospital for\na straight period, making a total hospital period of about 31 months. At the end of this\ntime they graduate from the school of nursing and from the university with a BSe.N. I\nfeel that the result of this is that the nurses are turned out with degrees and are not\nprepared in either public health or in teaching and supervision. They have had enough of\nuniversity for a while and therefore, do not want to go back to study and I think it must\nbe harder for them to see the need for an advanced course. I felt this very definitely\nfrom Miss McCann. She is an individual who likes to work on her own. She does not like\nto take orders from anyone and I felt that she had a great deal to learn in public health '\nbut that she did not realize it herself, *~V#\nMiss Smith seemed rather discouraged about the whole nursing problem in Sask.\nThere is apparently a great shortage of nurses and she does not see much hope for\nobtaining anywhere like a full staff and that it will be a long time before they can\nobtain trained people, (See notes and key form for the province),\nI had a very interesting day with Miss McCann who is the nurse for the district , I\naround Regina. She travels in a circle, about 100 to 125 miles south and then north-west:\nto the Moose Jaw region boundary and north about 100 miles. I rather gather that she\nand another nurse, Miss Brett, are often sent out on special Projects. They do very\nlittle school work. Their area is so large. Miss McCann was going with Dr. Clancy, who\nis a case in himself and who is a municipal doctor, for the immunization program.\nDr. Clancy apparently is one municipal doctor who keeps the immunization program up t\u00C2\u00BB:dBg\ndate.\n -}02-\nHe gives a booster dose for diphtheria and scarlet fever every second year He visits\n\u00C2\u00A3\u00C2\u00A3 st\u00C2\u00A3 l:^ sernd tt\u00C2\u00BB ,doing one-haif -* ^ra^s ^ JSoTSS\nS?%h~ J^Sf ? \u00C2\u00B0Sa^ly *\u00C2\u00B0 ** ^astioned but he knows the people in the district\nand 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\nalways the routine to have the nurse go with the doctor. Of course, in many of them\nimmunizations are not done. The district nurses are not certified to give immunization.\nMiss McCann said that other projects include organizing for the T.B. survey; checking of\nV.D. contacts and following up the cases discharged from mental hospitals. The nurses\nseem to like to do this work. I felt that in this district and I suppose it is true in j\nall other districts, the nurse is just touching the high spots. I suppose that it is\nbetter that there be one than that there be none at all. They do a certain amount of\nschool work. They will visit a school, inspect all the- children, there are no medical\ninspections. Make out a family folder and card for each child and then, while they are\nin a community, visit every home, whether there are defects found or not. They may not\nbe able to do this in a school more than once in four years. It seems to me that here\nis where something ought to be worked out with the teacher, the nurse going in as\nconsultant to them. She would easily be able to contact all schools each year or maybe\ntwo times a year on this basis.\nJtert Sanatorium - On Saturday I had an opportunity to go to Fort Qu'Appelle and visit\nthe San. for a short period. Miss Pearston is the lady superintendent. There does not\nseem to be any definitely organized staff education program. There is no medical social ,\nmarker 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\nyears in this work. She has devoted her whole life to the erradication of T.B. This\nflavours of personality. Miss Pearston has about 22 nurses and 38 nursing assistants, I\nbelieve. These are not tkained nurse aides, they are brought in and just given some on-\nthe-job training. They have a good program for affiliating students but do not have all\nstudents from all nursing schools. All the staff are given B.C.G. They have an in teres\nting department called \"Prevent\" babies born of T.B. mothers are kept there and given\nB.C.G. and are not discharged until they are nine months old or so. They are also given\nother immunization*,\nf\"T,pP ^GION #1. SWIFT CURRENT. Sasktt\nWe went to this region and stayed there for three days, October 25, 26 and 27.\nThis is a most interesting area as it is their demonstration area for complete medical\ncare. There is no doubt about it, that the availability of facilities for treatment is\na very great asset to public health work.\nDr. Simpson Matthews is the director of this region,\nsenior nurse.\nMiss H.I. McColl is the\nI\nIn the region there are six laager school units and three or four hundred local;1\nschool boards. Each municipality is divided into six townships. There is a total\npopulation of about 51,000.\nOn October 26th we took a very long trip around the region, covering 350 mimes.\u00C2\u00AB\nStarting at Swift Current, we passed through Gull lake, Maple Creek and had a side trip j\ndown to Cyprus park. We then went north to Fox Valley to the dental clinic and still\nfurther north to Leader, a third of their district offices. From there we drove to t\nSwift Current, arriving somewhere around midnight. The trip was a most profitable one.\nOur first stop was at Gull Lake, where we met the nurse, Miss Stolhandske, This is a\nsub-offiee of the Maple Creek District. Nurse Stolhandske has her living quarters and\noffice in the Hotel Clarendon. She trained at Medicine Hat, and her experience previous li\nto coming with the Health Region, about six months ago, was entirely hospital. She has I\n - -103-\nLrents J^^TS*0^ * f^i abOUt fifteen attend- She complained a bit that the '\n^^ J^^fS' ^^^tion. We felt that this, perhaps, should be encour-\n\u00E2\u0096\u00A0 Z^l-ll 8 a** ^bi6S ** her Centre *\u00C2\u00B0 ^ weighed. Her quarters consisted of\n!!?*\u00E2\u0084\u00A2^4If 2? 2 h2ffitting roora and office, and a second room was her bedroom\nwith partitioned off as a kitchen.\nu^ob1Gb11 k*e we Proceeded to Maple Creek where there is a very nice district\noffice which also consists of two rooms, an office and another roora where literature is\nkept and child health conference is held. The nurse here is Miss Caza. She has her\nliving quarters elsewhere. Miss Caza says she has about sixty-eight schools. She has\nthree baby clinic centres in addition to Maple Creek. These centres are held once a\nmonth. Her centre at Maple Creek is held one day one week and two days the next. She\nmay have as many as ninety come in for these sessions. Miss Caza has also only been with\nthe department about six radnths. Her previous experience had been hospital work. She\nseems to be quite a capable girl, but one cannot help feeling that both would benefit\ngreatly from public health training. However, they do a remarkable job without it. From\nMaple Creek, where we had lunch, we drove down to Cyprus Park. This took about an hour ai\nand a quarter extra. It is like an oasis in a desert, with lots of evergreens and\ndeciduous trees and is a summer resort. Returning through Maple Creek, we drove on to\nFox Valley where the dental clinic was in operation. This dental clinic is mobile ana\nis manned by two dentists and one dental assistant. It moves about from place to place\nand sets up in the community either in the school or in sorae other location where power\nis available. In Fox Valley they were in the Town Hall, right next door to the jail.\nThe usual procedure is to come into the community and to first examine the children in\nthe local schools, at the same time sending out notices to the schools in the surrounding\nareas, giving them one day appointment to bring in all the children. The children are\nexamined on this day and if it is possible, to do the work, it will be done then, otherwise, they are given appointments to return. This dental service is a part of the Medica]\nCare program and comes out of the medical care for all children up to sixteen years of agt\nDr. Oliver is the senior dentist and he has three chairs in the Swift Current regional\noffice. This is a very good service and the parents seem to be availing themselves of it.\nFrom Fox Valley we went to Leader where the nurse or rather where the nurses\nhave an old house as an office. The nurses are Miss Katarynych and Mrs. Doyle. Mrs.\nDoyle is resigning at the end of November. Miss Katarynych is also an untrained nurse.\nShe graduated from the Humboldt hospital and seems to have quite a flair for public\nhealth. She would benefit greatly by a course but like the others, seems to be doing a\nvery good job at the present time. The office here is being moved to new quarters which\nare very desirable. An old house has been brought in from the country and has been\nremodelled by the local garage operator. This is being rented to the Health Region for\nsomething like $45.00 per month. The nurse or nurses, if both live there, will pay $17\nper month of the rent. It consists of a very large living room, which will be the office\nand waiting room for child health centres. Another room off of it, which will serve as\nthe conference room and weighing room for the child health centre and a kitchen and\nanother bed roora which will be the living quarters for the nurses. From inspection of\nthese quarters we went to the new hospital. This hospital is one of the union hospitals\nand has been built for over a year. Miss MacDonald is the matron. She, however, is\nleaving at the end of this month and is coming on the public health staff. Her reasons\nfor leaving are rather serious. There is a young doctor, a graduate of Edmonton who\nconsiders that the hospital is hers. She treats the nurses like dirt under her feet and\nhas brought in nursing aides for which a salary of something like $125 is paid. She has\nsaid and told us there, that her nursing aides are a s good as graduate nurses any day.\nThis is a bit hard to swallow. Miss MacDonald told me that she would frequently go into\nthe office and go right past her and get one of her aides to dther assist at a minor\noperation or do some other treatment and Miss MacDonald would not know what was going on.\nMiss MacDonald is not the first of the matrons to resign for this reason. The only other\ngraduate nurse who comes on is one who works only five days a week. Miss MacDonald has\nbeen on call at night. The rest of the staff consists of seven nurse aides, who have not\nhad any training except that which has been given in the hospital. Some times they come\ndk\n -104-\nSev ^noWv ia\"SS1aat?rrtator **\" iS alS\u00C2\u00B0 * 3\u00C2\u00ABri0V\u00C2\u00BB situation becausa at *\u00E2\u0080\u00A2**\njllLt ^Jt7 4+ i^ lary and consequently the nurse aides leave there and come to\na ut L \u00E2\u0080\u00A2 ^^italis very nice. It consists of twenty beds, three cribs and I believf\neight bassinets. It has a surgery, a case room and x-ray department. We had some\nconversation with Dr. Larsen and I think we let her know what we felt about the nurse aide\nsituation and the fact that there was shch a shortage of graduate nurses in the hospital.\nI think we must have worried her a bit because the next day she phoned Dr. tetthews and\nwanted to know about the legality of operating a hospital without a graduate nurse in\ncharge. Dr. Matthews is going down next week to discuss the whole situation with the\nlocal authorities. Miss MacDoaald states that she is going to tell Dr. Larsen why she is\nleaving and is also going to tell the chairman of the union board, that is the local\nhospital board. It is rather a tough spot, especially since there is a shortage of nursej\nThe following are some points in relation to the program which I discussed with\nMiss McColl at various times.\nStaff Education - they have a conference every month from 9.30 to 4.30. In the other\nregions they usually have only half a day. They discuss administrative policies and then\nhave an in-service training program. Last month they discussed child health centres\nwhich included the use of volunteers, conferencing, records, etc. Next month they plan\nto take up orthopaedic defects. This will include what to look for in the pre-school and '..\nschool child and a demonstration of a home visit. The following month they hope to take\nup a mental hygiene program.\nMental Hygiene - the clinic has not started yet but Miss McColl told me the routine which\nis carried on in Weyburn and Moose Jaw and which they hope to carry on there. They will\nstart first with the Swift Current school and will have one clinic a month. The child\nis first referred to the family physician. Then the nurse discusses it with him and he\nwill write up a kftmmt history. We discussed this program later in Moose Jaw with\nDr. McKerracher and Dr. DeMay. They emphasized this principle of referral to the\nfamily physician, and said they never have had one decline to send the child to the\nclinic. Procedure will be to tcike up only one child at each clinic. The nurse and\nthe doctor conference first over the history. The child is then interviewed by the\npsychiatrist, the mother is interviewed, and then the mother and child together.\nFollowing this, there is a short conference of the nurse, teachers, doctor and parent,\nand following this suggestions are made. Then there is a conference at the school with\nall of the teachers in that school. The conference which we oc\u00C2\u00B1\u00C2\u00B1 saw later in Moose\nJaw was a little variation to this. We first went in on the conference just after\nlunch time with the nurses and psychiatrist. The Psychiatrist had seen cases in the\nmorning, and was to still see cases in the afternoon. Following the afternoon cases,\na conference would be held with all of the teachers of the school from which the\nschool child had come. Dr. McKerracher emphasized that their program was educational\nand they keep the case loads small on purpose. The cases are chiefly of three types:\n1) those instituted by the family doctor; 2) those referred from the school, and they\nonly take one case from axik school each day; and 3) those referred by the nurse. , '\nThe nursete part is very important in all of this. She always prepares the history I\nand is present at the conferences, and does the follow-up work. An interesting part\nof this program is that in addition to pre-school and. school children, adult cases are !,\nalso referred. This makes a wide variety for the nurses. Dr. McKerracher is quite\nconvinced that the public health nurse is the one to do the follow-up in the community.\nMiss McColl said that they consider the mental hygiene program to be 75% educational\nand 25% service. In connection with this, the course which is given at the mental\nhospital for public health nurses , social workers, teachers, etc. is a very helpful\none. This course is one month in length and nearly all the public health nurses in the t\nprovince have taken it. They have some very practical work in the preparation of\nhistories and the understanding of these cases.\nReturned to Swift Current region. In relation to the schools, there are about I\n350 schools in the whole area. The nurses have done the basic inspection and imrauniza I\ntion\nmmmma\n^^di\n -105-\nE* b^\u00C2\u00ABCf^W\u00C2\u00B0irnSi8^ ^completing the cards and examining the children thorough'\n^* ii!11' f *! I \u00C2\u00B0T tW\u00C2\u00B0' ^ey do a raPid inspection, although if the school is\nrery small, say about ten pupils, the nurses feel that when they set up, they might as\nwell do all the children. So, in effect, a basic inspection is done each year in those\nsmall schools. In the town schools the teacher weigh. In the rural, the nurses do this.\nThe nurses do not test vision in any of the schools. The nurses are doing a very fine\npiece of work in attempting to have the teachers establish a hot lunch program. They\ntalk to the parents in the community and then try to arrange an organizational meeting.\nU41J , J* relation to communicable disease control, if the teacher excludes the\nchild she will phone to Swift Current or contact the nurse. The nurse or the office will\ncontact the family doctor and the nurse will visit the family if at all possible. She\nwill not inspect the class. This is left to the teacher, unless of course, it may be for\none of the more serious diseases. In relation to sanitation, the nurse inspects the\nschools and sends in a report. If there is a school which is in bad condtion and she\ndoes not get the cooperation of the local school board, then asks the Sanitary Inspector\nto go out.\nPre-Natal - there is no organized pre-natal program,\nopportunity possible for teaching.\n.But the nurses make use of every\nChild Health Centres - There are some 26 or 28 of these established and Dr. Matthews\nsays that by next year there will be about 35. They seem to have gone all out for this\nin this Region. It is rather adaptable to it because there are a number of small\nvillages. In the Moose Jaw Region, which we saw later, there are very few and so they\nhave not been able to establish clinics in the more rural centres. They usually have two\nrooms. If it is not possible to have two rooms, they try to screen off a part. In most\ncases, the nurses are reported to be using volunteers. The volunteers act as hostesses.\nIn the one clinic which I saw in the airport built at Swift Current, there was quite a\ncrowd and no volunteers were being used. Miss McColl had to take this clinic herself\ndue to a shortage of staff. She said that the nurse who has been there did not believe\nin using volunteers. Miss McColl felt very definitely that there should be some. This\nincidentally, was a grand place for some pre-school teaching. In most of the Centres the\nnurses have the mothers come on the appointment basis. All the nurses like the Metropolitan guide which they have.\nAn interesting part of their work is attendance at the Teacher's Institute.\nEach larger school unit has a convention once a year and then each of the smaller units\nwithin the larger school unit has an Institute twice a year. This consits of a whole\ndays program and the nurses are attending them and speaking to the teachers in relation\nto the school health program. They are gradually trying to encourage the teachers to 'M\ntake some of the practical procedures^ji^h as weiring and measuring, vision testing, etc,\ninto their health teaching. A very^Kstitute which I imagine is rather typical, was\nattended in the MoesSe Jaw Region. (This will be described later).\nMiss McColl emphasized the need for public speaking on the part of the nurses4\nThis need of practical field work is probably one reason why it is not wise to concentrate\nthe training in those universities already established where there are alseady established,\ncourses in Canada. They would be too large a group to get the practical experience\nnecessary. Miss McColl seems to be encouraging her nurses to do a lot of community work.\nThis springs probably, from the fact that she, herself, is primarily interested in\nteaching. The nurses each take about four home nursing classes a year. I discussed these\nwith Miss McColl and it is my feeling that some of the classes, at any rate, could be\ntaken by graduate nurses in the community. It might not be possible to find some in all ct\ncommunities, but it would certainly be in sorae of them and think this would be good experience and be a meeans of drawing in other workers in the community. I do not know whether\nI convinced her of this or not because she seems quite set on the fact that the course\nshould be given by one person. The time spent at Swift Currnet was very profitable indded\nI am more than ever convinced that there is a need for a public health nursing course at i;\nthe University of Saskatchewan and a great need for a revision of their present basic\nmWBP**\n '.. dm\\n -106-\nMOOSE JAW HEALTH RE~G~ION\nOn Wednesday, October 28, 1948, we spent a day in the Moose Jaw Health Region with Dr.\nKinneard and Miss Code who is the senior nurse. Miss Code has just completed her\nadvanced course in Administration at Toronto University. Our first trip was to a rural\nschool about forty miles out of Moese Jaw where one of the two yearly institutes was\nbeing held. About 26 teachers were in attendance. Mr. Winters was the superintendent.\nHe called on Dr. Kinneard to speak to the group. Dr. Kinneard gave a most interesting\nand stimulating talk to them. He started out by saying that they take the teacher into\npartnership. He urged them to be clerically minded. He brought to their attention a\nbooklet - \"What the Teacher Sees\" and said that perhaps it should be named \"What the\nTeacher Ought to See\". Before showing them this booklet he explained their method of\ndoing the school health program. The teacher screens the child, puts her findings down\non the record. Then the nurse screens and the doctor sees those with remedial defects.\nHe sees them at one centre and children from other schools around about are brought in.\nThe parents come too. Then there is a conference with the nurse, teacher and parent.\nA follow-up home visit is done if the parent does not come. Dr. Kinneard then went on\nto say that he wants to convince the people of the Region with what the newer knowledge\nof nutrition has to offer. One way to do that,* he feels is to get a program going in the \u00E2\u0080\u00A2\nschool that is not as dry as dust. The child will then be the ambassador to carry the\nknowledge back into the home. He would like to see in each community a local nutrition\nstudy club. He stated that we had been talking about school lunches for forty years\nand have got exactly nowhere. He brought into his talk that we want to educate for\ncomplete living for the child. He felt that we were not doing that to-day. There follow-.\ned a discussion program on the hot lunch. Only two out of the group had a program in\noperation, or being planned. One or two spoke up in favour and one or two against the\nprogram. There seemed to be three types. The first which Dr. Kinneard described as\nmerely a gesture. This is where the child brings the ingredients in a jar and this is\nheated up in the school. The second is where an extra dish is prepared and the children\nhave it and the third is where a real meal is prepared and the children sit around and\neat together. He brought out the possibilities of teaching in this and talked about\nmany of these children never at home being able to sit down to a meal properly and\nlearning the right table manners etc. One teacher spoke up about a program she had had\nat one time. She lived in the teacherage next to the school. She had two older girls.\nShe had the parents discuss a hot lunch program and all were in favour of it. Each\nfamily was to donate something. They planned on a two dish meal such as potatoes and a\nvegetable. Even though there were some poor families in the communities they all could\ncontribute something. The potatoes were prepared the night before by the teacher, she\nfelt that she was not sacrificing too much to do this. Then the hour before lunch time\nan older girl in the teacherage studying and seeing that the fire was on and that the\nmeal was cooking. The children then sat down to a table and they all enjoyed this very\nmuch and there were great opportunities for teaching as she said. I really felt that\nthis was a very stimulating thing to be able to attend this part of-the institute and to\nsee how the Health Dept. and the Dept. of Education are working together.\nJust after we cajBback into Moese Jaw we sat down at the conference j*ith the I\nnurses and Dr. McKeracher. This has been described under the Swift Current Region.\nLater on in the afternoon, we sat in on the conference which was held with the teachers.\nI did not discuss the program in all details with Miss Code. In relation to\nstaff education, they have a meeting every Saturday morning which includes all but the\ntwo nurses who are situated outside the city. Once a month they come in. They take up\nadministrative policies and staff education. Dr. Kinneard also attends. There is a\ndistrict office at Morse and one at Central Butte. There are two purses working in the I\nrural areas, one at each of these offices and two more working in the rural areas but\nout of Moose Jaw, and two in the city. Three of Miss Code's nurses (six) have had a\npublic health nursing course, so that she is better off than Miss McColl in this respect.\n -107-\n, u ~>A *u i Health Centre was in operation in Moose Jaw in the afternoon. It\nis held there on Monday, Wednesday, Thursday and Friday from 1.30 to 4.00 p.m. and is\nby appointment. Two nurses are in attendance. They each have a conference room which\nis equipped with very nice cupboards, a table for the scales for weighing and measuring\nand a desk and chairs for conferencing. Each nurse has her own immunization outfit and\nthe complete work for the mothers. There is not a volunteer in this centre but the\nreceptionist, whois full time with the department, draws the records and makes out the\ncard, in effect/~She does the same as the volunteer would do. The large hall at the\nentrance is very attractive and there are sorae rocking horses, etc., which have been\nmade at the technical school. The few children which are there at one time because of\nthe appointment system, make very good use of these and they are very popular.\nDr. Kinneard is a very interesting person and does a great deal of contact\nwork in the community. He does not believe in having a health educator in the region,\nhe feels that the doctor and the nurses are the health educators and he has done a great\ndeal of work in community forum development. He has a radio program every Monday night\nfor five minutes at 10.25 p.m. He apparently is very good at this. There is a very\ngood library with magazines and books. These however, are mostly in the doctors office\nand one wonders just how much the nurses fxmn come upstairs from their office to make\nuse of them. I rather doubt that they do and as a matter of fact, Miss Code said that\n$hey do not use them very much0\nIn relation to the school program, Miss Code says that in the city, the\nteachers are weighing and measruing the children and testing the vision and hearing.\nThey are getting away from the routine in a very effective fashion apparently.\nMiss Code and Dr. Kinneard speak to the Normal School students and they also\ngive lectures to ikx both schools of nursing. Miss Code is hoping also to have the\nstudents from the schools for at least one days observation.\n r\n-108-\nindustrial nuking\n\u00C2\u00A3nt g1o v^sif1 fSal^Wa^f e, Consultant in Industrial Nursing of the Ontario\nDept., to visit a few industries in Toronto, to get a general idea of what is being\ndone in industrial nursing. The trips were arranged to six industries, two of which\nhave public health nurses, and Miss Wallace considered as very good. Two who had nurses\n?\u00C2\u00B0il!r5 ? P health and were doing a fairly good job and two nurses, not public\nhealth doing an average job.\n1. George Weston Co., Ltd. This industry is a baking plant. There are several firms\nacross Canada. The one which I visited was on Peter St. and there they made biscuits r\nonly. There are about 350 to 400 employees, with women being slightly in the majority.\nOf these, about 15 to 20 have taken their First Aid and they are at strategic places\nthroughout the plant. The medical room referred to as \"Medical Services\" is very small\ncramped quarters, just off the office on themain floor.\nDr. Harrison is the medical director for Weston's for all Canada. He, however,i\ngives personal service to two of the plants, this being one of them. The other is the\ncake and bread shop on Dupont and Christie Sts. He spends one hour each day for five\ndays of the week in the plant on Peter St. Dr. Harrison seems to have a fairly good\napproach to industrial hygiene. He emphasizes the medical aspect. He gave me a paper\nwhich he had written entitled \"Experience in Health Education and Industry\". He also\nreferred me to another which was published in the October 1948 issue of the Canadian\nMedical Association Journal. The nurse at this plant is Miss Bishop. Miss Bishop is a a\ntrained public health nurse who had experience in V.O.N, work before going into industry.\nShe did not want to go into industry at all but started in with hourly service from the\nV.O.N, and then was persuaded by Dr. Harrison to give her full time. She now likes it\nvery much. She recently attended a Congress in England. Her expenses were paid by the\nWeston Co,, and there she presented a paper on \"Industrial Nursing in Canada\", Dr,\nHarrison started out as a plant doctor giving hourly service, but fifteen years ago he\nbecame the full time medical director. He employes private practitioners as medical\nabtexziBDOE doctors for the various plants throughout Canada. He is quite sold on public\nhealth training for the nurse in industry. When asked why, he said - the public health\nnurse knows much more about how to handle people. The R.N. has no conception of what\npeople live like at home. The R.N. tends to go in and just do first aid. She forgets\nabout the public health angle and about the nutrition education. (Dr. Harrison is very\nstrong on nutrition). He said that formerly he did not think that public health was\nnecessary but his ideas have changed and he is now sold on it. The General Electable\nhe said, had made a definite rule that they would employ a public health nurse where\npossible. When asked if he considered that the doctor should have special training in\npublic health, he felt that good experience in private practice was more essential and\nability to understand and deal with people, he stressed as* a most important aspect.\nMedical and nursing program consists of a pre-employment examination. The\npersonnel department when interviewing new employees or rather new prospective employees, '\nrefer the applicant, man or woman, to the nurse. She fills in a part of the medical card\nShe asks them questions about their health and general attitude. If they give a history\nof having had bronchitis or otitis media they are not considered since they have found ,\nEat these are hazards for the baking industry, de nurse fills out as stated before,\npart of the medical history, takes the blood pressure, urinalysis, Wasserman. Tests the |\neyes and haemoglobin, also gives them a sheet for a diet survey, (see copy of forms).\nThe person is then referred back to personnel and told that they will becalled in for a\nphysical examination by the doctor in about six weeks time. Following the doctors M\nexamination, the nurse follows up for correction of defects. They do quite a bit of work\nin nutrition. If the person is markedly under-weight or over-weight they bring them\nback in two weeks and check frequently. They are sent for an x-ray, the charge is 50*\na plate for all those going to the Gage Institute. Unknown to the patient, the nurse\ngets a social history. If it is anyone she is in doubt about, she clears with the\nSocial Service Index. This is not usually a service which the Index permits to industrial\n call.\nThere are no regular calls made by the doctor to the plant.\nThe program ponsists of pre-employment examination. The personnel office which\nemployes workers refers the women to the nurse. She does her examination, makes out\nune card, inere is no further examination made by the doctor. The tests done are blood\npressure and urinalysis. There is no routine x-ray. For the men, the employing officer\nmakes an appointment with the doctor and he examines them and completes the card and\nsends it to the nurse. These medical cards are then filed in a locked cabinet. If there *\nare defects, the nurse calls the employee down and recommends correction. I do not know\nhow close follow-up there is on this. The second part of the program is first-aid and\nthis seems to be the chief part. The nurse has a card for each employee on which she\nnotes why the person has come down. In addition there are various lists that have to be\nmade out for the employers. There were about a half a dozen in during the hour to hour \u00E2\u0096\u00A0\nand a half which I was in the nurse's office. I did not hear any evidence of any health\nteaching. I would not say that there is very much educational work done. The nurse\ntakes the attitude that there are enough agencies in the community and that these are a\nfairly good type of employee and therefore they do not need much health teaching. There\nis no special work done in nutrition as in the first industry visited. The nurse stated\nthat they have a safety committee which makes a tour of the plant every month. As far !\nas I could make out, this committee is composed of the foremen. She is not on the\ncommittee. They report findings to the safety engineer. She says that the company is\nvery safety conscious and that she is teaching safety all the time. She means that she\nis doing this when they come in for first aid. She makes a tour of the plant once a mm\nmonth to replenish the first aid boxes. She also visits the women's wash rooms once a\nweek to replenish kotex cabinets.\nIf an employee is ill he telephones in to the nurse and she notifies the\nforeman. They can be off two days for which they get two-thirds pay. If they are off\nthree days they must have a doctor's certificate to which time they will get full pay\nuntil they go on sick benefit in eight days.\nThere is a cafeteria operated by the C.N.I.IP. but the nurse does not supervise '\nthis. She has standing orders but they are not signed by a doctor. She does not have\nvery much to do with community agencies and one feels that there is not much referral or 1\nunderstanding of need of referral. Whereas Miss Bishop had a card to give to the employ- !\nees for the Canadian Mother and Child, Miss Grogan does very little of this type of\nthing, if any.\nWhen asked what preparation the industrial nurse should have she said they\nshould have some private duty. When questioned further her reason was that she needs the fl\nprivate duty in the average home so that she will see what the workers life is in the\nhome, I pointed out that it was most unlikely that any nurse would have this type of\nexperience now. She felt that the chief things that the industrial nurse needs to know\nis the emergency first aid, which is most essential and an understanding of people and '\ngood common sense.\nIn comparing these two industries one could see very definitely how thepublic i\nhealth nurse can make use of opportunities as where the nurse without the public health f\nbackground does not realize the opportunities there are for teaching.\n3. Amalgated Electric, 384 Pape Avenue. This is an industry where they make all kinds\nof electrical equipment. There are around 600 plant employees and two hundred office\n\u00E2\u0080\u00A2raplovees. About two-thirds of the plant employees are men. There does not seem to be\nany special industrial hazard in this industry. The personnel consists of Dr. Thornton\nwho spends two hours, five days a week with the industry. Miss Orchard, the nurse in\ncharge and Miss Tindale a younger nurse. Neither Miss Orachard nor Miss Tindale have had\npublic health.\nTh\ne program consists of a pre-employment examination. This is given befor,\n 111-\nthey are taken on. The nurse completes the first few items on the medical card and then\nthe prospective employee goes to the doctor. The doctor apparently gives a very thorough\nmedical examination. He tests the eyes. There are no tests such as hemoglobin or\nWasserman given. The nurse was rather horrified when I asked about these. She does not\ngo in with the doctor when the girls are examined. She does not try to follow up any\ndefects. This is the responsibility of the employee and the family doctor. The doctor\nhimself does not do much about it. All employees must have an x-ray. There is a safety\ncommittee and the doctor is a member of this but the nurses are not. Miss Orchard stated I\nthat there is a safety man who goes about the plant all the time. He does not consult\nwith the nurses or they with him. The nurse inspects the wash rooms once a week. There\nis no educational program. There were several employees in the dispensary when I was\nthere, but there was no evidence whatever of any educational work, it is essentially a\nfirst aid service. There is no use of or referral to community agencies and I would\njudge, very little understanding or knowledge of them. There is a cafeteria which is\noperated under Industrial Foods. They have a dietitian in charge. Miss Orchard said\nshe would never think of inspecting the kitchen with a dietitian there. There seems to\nbe a great deal of clerical work. Miss Orchard did not feel that the industrial nurse\nneeded any special qualifications. I talked with the doctor briefly, he siad they try\nto examine all men over forty years of age once a year. He says that a fair percentage\nof the work outside of pre-eraployment examinations is applied psychology. The employees '\nwill come in and talk to him. He remarked that sometimes they even break down to Miss\nOrachard.\nI had a definite feeling that Miss Orchard was resenting my observation. I\nfelt that perhaps the purpose of my visit was not explained to her. She did not seem\nat all interested. She would sometimes break off in the middle of a sentence if an\nemployee came into the other room or if the doctor appeard at the door it was \"Yes\nDr. Thornton\" and up she jumped. There are allsorts of missed opportunities here. I\nasked what would be done if there was a pregnancy. If a married woman becomes pregnant ,\nthey are allowed to stay on for five months but they do not hear about it until she is\nready to leave. If it was an unmarried woman, I asked what would be done, she replied -\nwe will wait until that arises. Apparently they have not known of any such cases. i\nThere is no attempt made to refer prenatals to prenatal classes. Miss Orachard said that\nis up to their own doctor and sometimes the doctors resent it. :; 1\n4. York Knitting Mills, 900 Queen St. W. There are a total of about 55o employees.\nAbout sixty percent men. The medical roora is up on the top floor. There are very\nspacious quarters, A small waiting room, a large dispensary, a doctor's office, two\nexamining rooms and a drug room.\nDr. Gerred spends one hour each day at this industry. The nurse is Miss\nShe has not had public health training. Sees to some extent the\neducational opportunities. She is rather a nervous type herself\nThe turn over in this plant is apparently very great. The employees are,\ntherefore, not given a physical examination until after they have been there about three\nweeks as they have found from experience that if they stay for three weeks they will stay\nmuch longer. However, the nurse does check all before they are hired, the personnel J.\nmanager goes into the social aspects very thoroughly and the nurse seems to leave all of\nthis to that department. The nurse does a hemoglobin, a urinalysis. The doctor does the,i\nblood Wasserman. The nurse reserves one afternoon a week for the visiting of sick\nabsentees. Only 19% of the visits are for occupational, that is, first aid injuries in |\nrelation to occupation, the rest are minor medical and surgical cases. She does very\nlittle health promotion work, although I think she has made some effort to do some group\nteaching but did not get the cooperation of the management.\nMiss Banting had two months public health in her basic course. She thinks\nthe nurse who has just graduated might be a better bet for industry than the nurse who\nhas been doing private duty because the the nurse who has just graduated would be\n -112-\n\u00C2\u00A3\u00C2\u00A3* ^aELS^1^1^^ She feels that the public health course is too\ni\u00E2\u0084\u00A24\u00C2\u00B0\u00E2\u0084\u00A2 * ShS g0t quite a bit i*\u00E2\u0084\u00A2 the refresher course in industrial\nnursing.\n,,-, 1 * IJW!?ld\u00C2\u00ABr^nk this Program definitely higher than that of the Amalgamated\nElectric and the Colgate Palraolive. It is however, not as good as the Weston and\nthe Christie Brown which I visited next.\n?;v,4CbTiS+ue ^OW?' ?** St# Eo There are about *\u00C2\u00BB\u00C2\u00BB0 employees. The Health Centre\n2 P Where this name has ^a11 oh the door) is on the fifth floor\nand one can perceive a very nice atmosphere when going in. There is a small waiting\nroom where there are very attractive fcealth posters and some health literature. Then\nthe dispensary and a smaller room off that where Miss Smith has her desk and a recovery\nroom off this room. There are two nurses at Christie, Brown's. Miss Smith who has had\nj public health and Miss Hanna who has not had public health, but is very bright and seems\nvery appreciative of having the opportunity to work with Miss Smith and larn from her.\n|Miss Hanna does most of the treatment work I would judge. She also takes her turn with\nI Miss Smith in going about theplant. Miss Smith will be going on to the new plant which\nI is being built and Miss Hanna will be taking over here from her. Dr. Bell is the medical\nofficer and visits the plant sometimes for two hours a day and sometimes for one. He\naverages up to 20 hours per month. He apparently is very public health minded and Miss\nSmith considers herself very fortunate in being able to work with him. Unfortunately\nhe was on holidays and I was not able to see him.\nThey are not able to give a pre-medical examination before employment because\nthey have a very great turn-over and also a great back log of work. Neither does Miss\nSmith see the employees before employment. She is however, planning for a pre-employ-\nI ment nurse screening. At the present time they all have their medicals after they have\nbeen in the plant for two months. They are also planning to do periodical medicals\nevery two years.\nMiss Smith incorporates a great deal of health education. Everyone is given\na nutrition survey form as at Weston's when they are given their pre-medical. Miss\nSmith plans to follow up the medical examination every month until defects are corrected\u00C2\u00AB;\nShe also follow up prenatal cases and brings them in each month as soon as she knows of\nthe pregnancy. Miss Smith feels that thepossibilities in industry are very great. A\nlist of the items which appear on their daily and monthly reports following, give an\nindication of the amount of work done and show that it is definitely not a first aid\nservice only. The total visits for occupational and for non-occupational indicate this.\nIn relation to preparation Miss Smith feels very definitely that the nurse in\n[.Industry needs public health. She does however, agree that with the present shortage\nwe probably should even say this for the smaller industries. She feels that if the\nnurse is given some staff experience with V.O.N., or if we even said that the nurse,\nbefore going into industry should have some experience in public health, probably in her\nbasic course. A second thing which would help would be adequate consultant service on\nthe provincial level. The refresher courses, Miss Smith felt were not very good as\nthey had been given. The nurse with public health finds that it is a rehashing of her I\ncourse. The nurse without public health finds that it is above her level. The industrial nursing group under the public health of the registered nurses association is\nanother avenue of education.\nIn reference to Miss Smith's work - she makes a tour of the plant every week.\nThe nurses alternate in this and they a re out of the office from one to two every day,\n|0n this tour of the plant they talk with and see every single worker on the job.\nDaily, monthly report (A) Occupational diseases and injuries\n1. slivers, puncture wounds, 2. burns blisters. 3\u00C2\u00AB abrasions, contusions lacerations\n -113-\n4. infected wounds. 5. S.B. and I. 6. eye injury or inflammation. 7. fractures and\ndislocations. 8. strains or sprains. 9. medical conditions. 10 repeat cases.\nTotal occupational, July 683, August 585, Sept. 517.\n11. Safety committee report, July 8, August 7, September 9.\n12. W.C.B. report, July 10, August 4> September 6.\n13. Sent to St. Michael's, July 7, August 2, September 4.\n(B) Non occupational diseases and injuries,\n14. skin diseases and conditions, 15 pyogenic infections. 16 headaches. 17 head\ncolds, 18 chest colds, 18 sore throats, 20 flu. 21 eye. 22 ear. 23 nose, 24 feeth,\ngums and mouth, 2$ G.I.system, 26 G.U. system, 27 legs, 28 feet, 27 abrasions and\npains, 30 rheumatism, arthritis, 31 heart, 32 nervous, hysteria, 33 fatigue and heat\n34 fainting, 35 dysmennorhea,36 injections, 37\"over-indulgence\", 38 non-occupational\ninjuries, 39 other medical and surgical conditions, 40 repeat cases.\nTotal non-occupational, July 1083, August 949, Septemebr 1074. 41 functional, July\n111, August 66, September 52, 42 functional component, July 58, August 29, Sept. 30.\n(C) Health promotion - 43 pre-meds. 44 chest x-ray appointments, 45 underweight\n46 overweight, 47 anemia, 48 tests, special, 49 defects corrected, 50 pre-natal,\n51 consultation.\nTotal health promotion, July 265, August 246, September 299.\nBack to work, referred to family physician, dentist, wfes clinic, etc, community\nresources used, oyer all total - July 2031, August 1780, September 1950. In August\nthis meant l.S^/P&i5 employee per month. In September 1.64 visits per employee per\nmonth. Daily average, July 92, August 85, September 88,\nPhysician's Report p Complete examination, new - periodic. Consultation, medical,\nsurgical; Consultation, surgical; surgical. Compensation\nCases.\nTotal personnel seen 69 (July); August 50; September 54\u00E2\u0080\u00A2\nConference.\nReferred to F.P.\nTotal hours, ffA|y 20; August 17; September 14.\n Bell Telephone floT -113A-\nSpent two mornings with this company. The head office is on Adelaide Street and there\nare something like 5600 employees in greater Toronto. There are very fine offices in\nthe medical suite at the head office. There are two part time doctors and two nurses\nt * L?eiWL?# J do Pro-placement and periodic examinations. In addition to the\nhead office there is another office on the ninth floor of the same building. This is\nthe service for some 1,000 long distance operators. There are two nurses full time there\nOne of them has public health. One of the nurses in the head office has public health.\nThere is a eentre on Bay and Grosvenor with about 900 employees, with two nurses, one of I\nwhom has public health.\nI did not observe any interviews for pre-placement or periodic. However, in\n^talking with the nurse I did not have the feeling that there would be a very great deal\nof health education done. On the ninth floor, the nurse, Miss Stanley, does not miss as\nmany opportunities. In the long distance section, there is something like a 50% turnover in employees. Miss Stanley interviews all new employees and she sees them at\nleast once yearly. The sytem is fairly new and she is trying to build/ it up. She has\na tickler file for all problem cases and says she does quite a bit of health counselling.\nShe feels that the greatest benefit from public health training comes from mental hygiene\nShe took her public health course in 1945 in Toronto.\nThe next morning I visited Miss Ball at the Kenwood exchange. There are about\nP2BQ employees there and she is at this office from 10 to 12 every morning. In addition\nshe has three outside work centres or garages. She visits New Toronto once a week;\nWeston, once a month} Islington, once a month and in addition has other commercial\noffices. She says that when she visits these outside places that it is mainly taking\n^of blood. They do all the women once a year, and then try to do the low hemoglobins\nevery month. She is responsible for sending the employees in for periodic examinations\nif they want to go. The nurses, apart from the head office, do not receive the history\nk which is taken, they only receive a card on which is the name of the patient and other\nidentifying information, the weight, hemoglobin and if there are any defects. Miss Ball\nfeels that the industrial nurse starting out now should have public health. She feels\nthat in the telephone system she does not need to know the outside agencies because i\nthey look after their own needs. The personnel department apparently do a lot of\ncounselling. In relation to pre-natals she said that she would know them all but very\nfew ask for pre-natal instruction. This is a case of a nurse not having had public\nhealth and very definitely missing out on opportunities.\nIn allthere are ei$it nurses in the Bell Telephone in Toronto, There is no\nsenior nurse, Dr, Wright says he calls the nurses in once a month for meetings, but\nthey are all individually responsible to hia.\n r\n-113B-\nOntario Civil Service Health Centre.\nThis health centre is situated on the fifth floor of the Bast Block of the Parliament\nBuildings. Dr. Hill is in charge, and there is another full time doctor, Dr. Gilchrist.\nMiss Green is the nurse in charge and there are two nurses working in this bldck with\nher. At the moment, neither of these two nurses have public health. In addition, Miss\nKidney is in a subsidiary unit in the main Parliament Building. Their service is for the |\n11,000 to 12,000 employees who are with the province. They all have to have physicals\nbefore coming on the perraanant staff. As amnxxacx many as possible are done In this unit,\nothers are done in Ontario Hospitals and those who cannot be contacted for examinations\nin this way are done through the private doctor. He is paid five dollars for the examination. The emphasis is on prevention and health education. (See outline of program\nand policies in file.) \u00C2\u00BB\nBass Green does quite a bit of teaching in the Industrial Nursing course at\nthe University. (This should be investigated.)\nEach new employee is given a very complete physical examination. He first of\nall is interviewed by the nurse. The nurse takes every opportunity possible for health\neducation. The initial interview is about 20 minutes, the tests that the nurses do\ntakes 10 minutes, and the doctor's examination about 30 minutes. That is one hour in\nall for a complete physical. Miss Green keeps closely in touch with outside agencies\nand uses them a lot for referral of her cases. The pre-natal cases are referred to the\noutskde agency, or if they are staying on at work, they are seen regularly In the office\nand given the nursing supervision. Over 90 a day visit this health centre.\n -113c-\nBell Telephone Cotl Montreal. p._Q.\n^S.^IsT^ h\u00C2\u00B0ffic! * Montraal\u00C2\u00AB *\u00E2\u0080\u00A2 Cruickshank is in charge\nOne does th* hi* litil7 1 \u00C2\u00AEy have ten nurses, none of whom have public health.\nThis reouest 5^1 % &Z 2*1 g\u00C2\u00B0eS \u00C2\u00B0n the foTjrth dar of absence of the employee. j\nSr^carex^inatio^r\u00C2\u00B0U^ ^ ~dl?al ^P\"*\u00E2\u0084\u00A2*- T*ay give pre-employment and\nf^M^l \u00C2\u00AB??\u00C2\u00A3*nations. The pre-eraployment information, as in Toronto, is kept in !\ndone IZtt Jt \u00C2\u00AB\u00E2\u0080\u009ESi iSxn0t 8fn b7 the nUrse out3ide- ^an asked if anything was\nmT, SS JIH ^'-5 re!!^Ved ^e ^^ ^P1^ *\u00C2\u00BB* n\u00C2\u00B0thing is done by the nurses.\nSf^+lf ^ lf an3rthin8 troubles them they always have the doctors. I think\nthe doctors see nearly everything, even of a minor nature and the nurses take very\nl^tl responsibility. Home nursing is the only group teaching which is done. Ctoe\nnurse. Miss Carter, seeras to be assigned to the teaching of individuals. I heard\ntelephone appointments being made for a couple of girls to come up to get their health\nteaching. A grand job could be done here if there were even one or two fully qualified\npublic health nurses to direct the program. There is no system of staff education or\nin-service training.\n 114-\nft)\nNovember 29, 19# - Spent two weeks following this date in Manitoba studying the city\n\ f Winnipeg and the Selkirk Rural Health Unit. On the first d^t with the Provincial\nConsultant Committee. Those present at the meeting were - Dr. Donovan, Dr. Elliot,\nMiss Russesll and Dr. Lougheed and Miss MacKenzie ffom the city of Winnipeg.\nDiscussion of their mafor problems.\n1, Lack of personnel,\nprovinces,\nThis seems to be quite a serious problem in Manitoba as in other\n2, They have had difficulties with transportation. This may be somewhat alleviated\nwith the government grant, some of which they hope to use for the purchase of autos.\n3. . Lack of stability of the nursing staff in the city. Over 50% who leave the job get\nmarried. There are many who like to go to other places. In Winnipeg the nurses are\npaid less than teachers, also paid less than Grade B clerks, whose salaries go from\n$150 to $180; the nurse goes from $145 to $175, this is a nurse without public health\npreparation.\nIn the afternoon discussed public health nursing with Miss Russell. In relatioi\nto practical nurses, she says they are being used in hospitals and nursing homes, etc.\nin one year they have licensed 148. Grade 8 and 9 standing is usual. They cannot get\na license before they are 21 years of age. They have experimented with the use of the\npractical nurse in the public health nursing field but it was not a success. Dr. Jackson\nwas most anxious that they be used and so they put one in the Brandon Unit, She was not j\nlusccessful there and was later moved to Selkirk and finally was released. Dr. Jackson\nhad an idea that she could do home T.B. visiting. However, she was only allowed to make\npressings, clean the bags and set up the clinic. She did not go out to the district.\nThis proved to be more expensive than having a clerk do the job.\nIn addition to their regular unit staff/they have eleven units set up and hope\nto set up thirteen morel They have a group of two or three older nurses. They call them '\n\u00E2\u0096\u00A0roving nurses\". If there is any physician who wants to do medical inspection in the\nschools or immunization in the areas which are not yet set up as units, they can call on\nthese nurses and they will go out to assist them.\nThere is a Health Education department with Miss Nix in charge. She herself\ngoes out talking. They did put a worker, trained in health education in the Selkirk\nUnit but it was not successful. It was felt that in order to keep her busy she would\nhave to do some of the job which the doctor and nurses should be doing.\nThe Selkirk and the Red River Health Unit are being set up as training centres.\nKellogg is giving $40,000 over a period of five years to develop these as teaching\ncentres. There will be centres for teaching all of their staff, medical, nursing, etc. '\nThey would like to have the nurse there for two months introductory training, and also\nto leave the prepared nurse there as a junior nurse, for a year. They would also take\nthe nurse who has not had public health nursing for a year. There seems to be a general\nbelief here that it is better for the girls to have a year in the public health field\nunder good supervision before taking her public health nursing course, i\nOne evening I had a long discussion with Miss Hart, who is directing the course\nat the University, This year she has 15 public health nursing students. All but one are \\nfrom Manitoba and all the Manitoba ones are provincial bursaries. Five are from V.O.N.\nThis is the only province for which they obsain assistance for the V.O.N, from the\nprofessional training grant. Just now the nursing group are studying how they can build\nup their school. It has been operating on a year to year basis. There does not seem to\nbe a readiness here on the part of the nursing to start an independent school nor to\nstart a university school. Miss Hart would like to develop a program which would give 1'\n -115-\nI MtSbrColLwa tt?ot f ^^aining in ^ ho3Pital, I urged her to get the plan from\nllwvl hav^ Itr^ 6lt th6y Sh0Uld not start out on the premise that we will\nbSffirl? \u00E2\u0084\u00A2IS /T TTe\" Jt is PerhaP3 wi3e that she work on the post graduate\n5?\u00E2\u0084\u00A2\u00C2\u00AB\u00C2\u00A3n\u00C2\u00B0 +r t flnds her own faat and gets the program well established. In\nth8Ht wf \u00E2\u0084\u00A2\ ? ^arS following the three years, she wants to give a degree. I felt\n^ .fhf * *\u00C2\u00B0f cal *J the first year to prepare the nurse for the first level\n, public health position. Then she should go out and get some experience and if she wants\nto return for a final year, that in that year she should be able to qualify for super-\n' ?n' ITW sure1y the courses to be given in supervision could be 'made academically\nsound so that a degree could be given.\nI ^x^ ** relation to the nursing shortage here, I had a long conversation with Miss\nPettigrew. She feels that the thing that they need to do here is concentrate on their\npresent school and try to get instructors prepared through the establishment of the\nI school at the university on a permanent basis. She feels very definitely that they need\nto concentrate on reducing the wastage of student nurses, which at the present time is\nabout one-third. She feels that it is greater since the eighteen year level entrance\nage has been in force. She states that now in Manitoba they recruit twenty-five of the\ngirls who graduate from high school into nursing. This is considered by educational\nauthorities as very high. They therefore, feel that it would not be wise to start a\n| new independent school because then the present school would not have enough applicants\nand the increased number of applicants would come from the students who are not so\n| desirable. In relation to salaries, the general staff nurse is receiving from $100 to\n$135 per month plus maintenance. Miss Pettigrew says that at Nanette Sanatorium the\nfive nurses on general staff receive $150 a month plus maintenance.\nTuberculosis work in Manitoba is under the control of the Manitoba Sanatorium\nBoard. Miss Wilson, who is an employee of the Provincial Health Department, works in\nItheir office, coordinating the work with the Health Units. All information in relation\nto the patient is sent to the Unit and every nurse knows all the T.3. cases in her\ndistrict.\nfwrnt-ir Health Unit . ,\nThe Selkirk Health Unit office is in the town of Selkirk, about 22 miles north '\nof Winnipeg. The Medical Director is Dr. Chown. Miss Wilson is the senior nurse but\nis very soon going to be on the Provincial staff as supervisor. This centre is to be\ndeveloped as a training centre for all of the new staff members and for students.\nSupport is being obtained from Kellogg for this purpose. The Unit consists of the munici\nall ties of St. Andrews, St. Clements and Brokenhead. There is a large foreign population,\nlargely Ukranian. One of the days I visited with a public nurse. The two visits which\nwe made were to Ukranian homes and I have not visited in a similar type of home where\nthe motherswelcomed the nurse more readily or had a better general knowledge of health. |\nThe social worker on the Provincial Welfare staff for a part of the Selkirk Unit Health\nArea has her office in the Health Unit. She is a Miss Bend, and although young seems\nto be very capable and very understanding. Her work has to do with Mother's Alo/6wance\nAdoption, Family Welfare, etc. As yet it has not reached the stage where the nurses are 4;\nreferring their cases to the worker for other this type of social welfare work. The E\nworker told me of a T.B. case who had been quarantined, together with his family, because\nhewould not stay in hospital. There was no move to consult the social worker or to\nask if she could do anything to help clear up this man's difficulties in this case.\nPerhaps she could not do anything but I think this is one field in which, at least the\nsocial worker might be used as a consultant.\nThe doctor^ is pretty well tied down to a routine school and child health\nI __ ^\u00E2\u0080\u009E -.JL j\u00E2\u0080\u009Evs o TOek. His time is given to one nurse on each of these\nZT S^f^uloTaIchool\"\u00C2\u00A3\u00C2\u00AB. -oming J%> a ehild health centre with the\nsame'nurse in the afternoon. W4 visited with Dr. Chown and Miss Wilson on their\n -116-\n~f^J^l!\u00C2\u00B0 \u00C2\u00B0ne^f tS,!t3Jdrk Sch\u00C2\u00B0\u00C2\u00B0ls* Ordinarily I do believe, the teacher\n\u00C2\u00A3*\u00C2\u00A3^ measures the children.** and has the vision tested. In this particular\nclass roram the teacher was not one who would do this sort of thing and the nurse sfcd *\nf \u00C2\u00ABS? a7 ^f?***0 PrePara the class for the doctor's visit. Ten mothers were\ninvited and of the ten, eight came. The quarters in which the nurse and do*tor had to J\nwork were very cramped. The doctor had a tiny little roora and the nurse interviewed\nthe mother in the hallway. She interviewed the mother before seeing the doctor and\nalso after seeing the doctor.\nWhile in the school I had an opportunity to look at the health education\ncurriculum. More about this later in the discussion of our talk with Miss Ring of the\nNormal School, I\nit\nTo date, transportation has been the difficult problem in the Unit as there\nhas not been enough cars to go wound. However, out of the Federal and the Kellogg\nGrants they hope to get more cars. Although Miss Wilson has not yet been relieved of\nher district, it is expected that she will be free for supervision in the new year.\nIn the afternoon,we observed the Child Health Centre which was held in the .\nP\u00C2\u00B0**\u00C2\u00B0An\u00C2\u00A3tonvolimteer8 \"ade ou* the new records and pulled the old records, A nurse,\nMiss lakla, who has just come on and is without her public health, weighed the babies\nand talked with the mothers. However, Miss Wilson, in another roon conferenced these\nsame mothers. I think that in the ordinary routine, she would have another volunteer\nto weigh and measure and she would have Miss Ancion with her to observe the conferencing\nand then to do some on her own. Following the conference with Miss Wilson, most of the\nmothers went into the doctor. It is not the custom of the nurses to change the formulas\nor to add to the formula or decrease it. Usually also, if the doctor feels the formula\nshould be changed he refers the mother to her own doctor. Ido feel that more use might\nhave been made of the strictly nursing conferences. It does seem rather a waste of the\ndoctor's time for him to be present at all child health centres. The nurses do not do\nthe immunization at the centres. In the schools they do the second and third doses and\nthe booster doses. They do not do any vaccination, ,\nI had an opportunity to meet with the staff after four o'clock one afternoon\nMiss MeLeod and Miss Henderson, the two nurses who have had public health seem to be\nvery good. It is their policy here to take on new nurses who have not had public health\nfor a year and then they will take the public health course. I am about convinced now\nthat it is a good idea, providing the nurse can be under proper supervision. I wonder\nhowever, if there are not a great many in the province who are not juinder this supervision. Miss Russell that there are twenty-two who are to take the course next year,\neight who are to finish their degree and there are twelve who have not had their public\nhealth course but are too old to be accepted at the University. That makes forty-two\nout of the sixty-seven nurses now working who have not had public health.\n^mkm\\m%dmtmmMm-rmtHr\nOn Wednesday morning I vidted in the district with Miss MeLeod. We did one !\n* school visit and a pre-natal and school visit. Miss MeLeod has a very good approach j\nand readily draws out the parents, I felt that she had a good understanding of needs\nand kiew just how much she should try to teach in the one visit. Observing her visits\nrather clearly pointed out to me that the official agency nurse who does not necessarily\ndo anything on her visit, such as weighing the baby and taking a temperature such as\nthe V.O.N, nurses do, can, through good interviewing, make a good approach and\naccomplish a great deal of teaching. It apparently, is the training of the nurse and\nher own personality which are the important factors.\nThe last afternoon we sat in for a few minutes on a conference which Dr,l\nwas having on a school child referred by the nurse because in her four years at school\nshe had not yet spoken to the teacher. This doctor is recently out from Scotland and\n -U7-\niLS^f^h^^^^^v,^ the \u00C2\u00B0ental hosPital In Selkir*. He seeras to be very well\nE?T*?JS! JT^ for the preventive approach to the whole problem of mental illness.\nThis is only the second clinic which they have held in the Unit and they are really\njus* reeling their way. Along with him was a Miss Wilks, a psychiatric social worker,\nshe was a nurse and I believe has had social work preparation.\nNormal School\n\u00E2\u0080\u009E. * ,,aS8,??ng, a P1*110 health nurse at senior nurse level on the staff of the\nprovincial health department is attached/ffie Normal School^ Th\u00C2\u00B18 8chool \u00C2\u00B18 ^ only\nresidential Normal School in Canada. It has between 350 and 400 students. Miss Ring\nis responsible for the health teaching. She teaches 18 hours a week. This means that\ntwo different lectures a week are repeated to nine classes. The so-called health\nservices are separated from her. On discussion, I found that what they called the\nhealth services, really amounts to the infirmary for the residents. This is looked\nafter by another nurse. Miss Ring, in addition to the teaching prepares the students\nfor the physical examination and goes over the results of the examination and tries to\nfollow up on the defects. From tallng to Miss Ring one would gather that she had a\nfairly good understanding of the objective of the program with the teachers. She felt\nthat she should have teacher training, in order to do th job. She has had public\nhealth training and a course or so in health education. She, however, did not have\nenough credits to take the health education course. The next day we talked with Miss\nMargaret Nix who is the Director of Health Education for the Provincial department.\nShe was a former school teacher and is a very enthusiastic individual. I think she\nhas found the sledding rather hard here. She apparently has retracted somewhat in\nher ideas as to the function of the Health Educator and seems to be thinking along\nthe lines which, we at least, feel are sound as the functions of a health educator.\nWhere she goes over the mark is in her enthusiasm and because of her background in\nchild development. She apparently has specialised in that subject. She therefore,\nfrequently speaks to community groups. This is where her function as a health educator and her background of information serves to confuse her function in the minds of\nthe Unit personnel. They naturally assume that all health educators think they should i\nbe doing that type of job and therefore, do not to have anything to do with them. If\nshe were less enthusiastic she probably would get the confidence of the nursing staff .\nmore readily. She has undoubtedly has a great deal of talent. At the present time\nshe has a health educator in the Dauphin Unit. She agrees that there is not enough\nfor an educator to do if assigned to one of the units as they are constituted today.\nShe would prefer to assign a health educator to three or four units. She would have\nthat person do community organization work, get groups together for education by the\nnurse and/or the doctor. Explain to the communtiy what the health unit is and so\nforth. She has just returned from a trip during which time she gave thirteen lectures\nin relation to the promotion of hospitals. This particular job has been assigned to\nher and whether or not it is heAlth education, she is going ahead and doing it. In\nthe future she hopes to have health educators who are specialists in certain subjects.\nAt the moment she is tninking of health educators who are specialists in nutrition.\nThey would be graduates of a home economics course who have taken their preparation in\nhealth education. She would use these in the units as consultants in nutrition and\nalso in the role of the health educator. This might or might not work. I am inclined\nto believe it might conflict in the same way as Miss Nix's special area of preparation\nhas caused a misunderstanding.\nTo return to the Health Education curriculum. In the curriculum for Grade\n1 to 6 it is stated, the services of the doctor or the nurse do not relieve, in any\nway, the teacher of responsibility for giving health instruction and going everything\npossible to provide for the good health of his children. When the teacher must make\nthe annual examination he should observe the following -\n1. Height\n2. Weight,\n3. Vision\n4* Hearing\n5. Posture\n -118-\n*^L8aCh ?* \u00C2\u00B0f th63e \" is exPlained how to make these observations. It states\nthat there should be a daily morning inspection and explains what forms this should\n^f\u00C2\u00BB J* th\u00C2\u00AE explanation it describes the healthy child and then the abnormalities\nwhich should be looked for. It outlines the teachers responsibility in communicable\ndisease. Apparently, Miss Nix was the one who drew up this course of study. Miss\nRing said that it was going to be revised. However, I am not so sure that this is so. ,\nMiss Nix is most anxious that a health educator be put in the Normal School. I think r\nshe is riggit in her contention that this position should be filled by a health educatoi\nbut one who has also been a teacher.\nVenereal Diseasen\nVisited the V.D. clinic which is in the Out-Patients Department of the St. Boniface\nhospital. This is the clinic for all of greater Winnipeg. The three nurses and\ndoctor are provincial employees. Miss Dickie is the nurse in charge. Miss Armstrong\nis also in the clinic and interviews all patients as they come in and as they leave.\nMiss Skinner does the follow-up. The follow-up consists of getting those who have\nlapsed for treatment and finding the contacts of every diagnosed case. All phtients\ncoming into the O.P, department of the hospital have a routine Wasserman and so do\nall the patients on the public ward. In October they admitted 60 new V.D. cases,\nin November 56. This was the lowest they have had for some time. Their total case\nload is around 600 syphilis and a much lesser number gonorrhoea. It did not seem to\nme that the nurses were very busy. I question very much the value of the initial\ninterview and the follow-up interview. As in other places, it seems to me, it is\ntaking away from the duties of the regular nurse of the O.P. department. It does not\nsees to me that Miss Dickie has much to do either. However, one cannot get a true\npicture in an hour. Dr. Backraan who is the doctor in charge, is negotiating to get\na social worker for those cases requiring case work and rehabilitation. They have\nbeen in contact with several V.D. divisions across the country to get their opinion.\nIt is rather doubtful that they can obtain a medical social worker but they are\ngoing out to get a qualified social worker and one who has the personality to do this\njob. This seemed to me to be a very favourable sign as as far as I know it will be\nthe first social worker to be employed in a hospital in Winnipeg\n -119-\nCity of Winnipeg.\nSpent most of the week with the Health department of Winnipeg. As is usual in tfets*^\n*vtaaff,health department, a great deal of the nursing time is spent on school work. Time\nI tfles are made up and the nurses spend most of the mornings in the school. The details\nof their work are entered on the form. They have two specialists, one a dental nurse\n\u00E2\u0080\u00A2who goes about the schools examining for dental defects. She does not use any instrum-\n:, ents other than a tongue depressor and to me, seems to be doing the work which the nurse\nI in the school should be doing. There is also a nurse who does the audiometer testing.\nI They use volunteers to assist with the adjustment of the ear phones, bringing the 5\nI children in from the schools, etc.\nWe visited two child health centres. One, held in the basement of a church.\nIt was very crowded and they were not making full use of an extra room. There were\nI four nurses. One nurse in charge who seemdd to float around, one nurse with the doctor,\nI (there is always a doctor present at the child health centres) and two nurses conferen-\nI eing. There was little, if any, privacy. However, there seemed to be lengthy and very\nI interesting conferences carried on. I looked over several of the records and very\njlittle of the conference was entered. Simply something about the feeding and immunization. The second was an immunization clinic. The child health centre is converted\ninto an immunization centre every third week. This is soon going to be every fourth\nweek. At this centre they have about 200 each day. The doctor gives the immunizations,\nthere is a nurse filling the syringes and assisting her. Another nurse getting the\nchildren in and two or three other nurses seeing that the records are made out, etc.\n; We had a considerable discussion with Dr. Day, Miss MacKenzie about having a separate\nI clinic like this. They apparently tried giving the immunizations at the regular clinics\nand found there was too much noise. This however, seems to me to be very poor psychologically. School children come to these clinics for immunization. This would not be\ngood if it were a straight child health centre.\nThey have a tuberculosis Consultant, Mrs. Saddington. She helps the nurses\nI with their cases, they go over problem cases, keeps a record of all T.B.'s and she\n[visits all T.B. patients in the various sanatoria. She claimed to me that she had\nmedical social service training but Miss MacKenzie says, not. She seems to be quite\nenthusiastic about her work and is doing a job which needs to be done, but for which\nI there certainly needs to be medical social workers in each of the sanatoria.\nThe Venereal disease is carried by the provincial. City nurses do not have\nany of it.\nThere is a supervisor in charge of nursing homes and foster homes and other J '\nwelfare institutions. She has nineteen nursing homes. In them there are 445 city\ncases. She is the only one to do any social service work of any kind witti them. She\nis responsible for the placement of the city cases in these homes, for the guidance and j\nplacement of private cases, for 4tas\u00C2\u00B1Kgx licensing and for seeing that they live up to '\nthe by-laws and regulations. She says there is a great need for boarding homes for the\nwell patient. She also has to license the 155 foster homes for children. The visits\nto inspect these homes are made through the district nurses but she has to clear with .\nthe Children's Aid.\nOne afternoon we spent sitting in on a child guidance clinic session. Dr.\nStevens is in charge. Miss MacKenzie has had quite a time trying to convince him that\nall nurses should take part in the history taking. He has wanted one special nurse. \u00C2\u00A7J\u00C2\u00AB\nThe nurses are however, doing the histories and sending the cases in. Sometimes they\nare notified of a conference and sometimes not. Frequently the workers go out to a\nschool to hold a conference on a child and the nurse may not be available, probably\nhas not been notified until they arrive at the school. There are no reports sent out.\nDr. Stevens insists that it is quite impossible to write a report that is simple\n -120-\nfenough to go out.\n,,. . ** the Children's Hospital the Health department have a nurse, she is not\npublic health trained, on the staff of the 0\u00E2\u0080\u009Et-Patient\u00E2\u0080\u00A2s department. She sits in a\nlittle office and on the door of the office Ss written\u00C2\u00ABSocial Service\". Her job is to\ninterview the new patients and those returning for another complaint. It is also hoped\n| that she can see the patient after seeing the doctor in order to do some public health\nteaching. However, with the rush of the work this seems almost impossible and Miss .\nMacKenzie has promised to give her more assistance. I discussed this matter with Miss\nMacKenzie and expressed my belief that we should examine these situations very carefully.\nWhere, for instance, does the duty of the Skii duty of the Children's Hospital in\nrelation to supplying staff end, and the public health department begin. At the present\ntime, the nurse in charge of the Out-Patient Department at the Children's is public\nhealth trained. She has a graduate nurse on her staff and uses two practical nurses.\nIn addition, she has students, for whom she tries to carry out a teaching program. The\ndetails of Miss Robertson's work are listed on an outline in the files.\nThe City Health Dept. has an older nurse who has been very interested in\nI nutrition and who wis doing nutrition work before the amalgamation and \"she is continufj\nI in that capacity but the work is not organized the way it would be if there were a\nI nutrition consultant.\nVictorian Order of Nurses\nSpent a couple of hours with Miss McKee who is the superintendent of the local branch\nof the V.O.N. She has, in addition to herself and an assistant 17J- staff nurses, of\nthese 8J- have public health preparation. The remainder are recent graduates, except\nfor one who had V.O.N, experience before her marriage and has now returned as a widow.\nAll the nurses are expected to take public health not later than two years after their\nemployment. Their program consists of (l) maternity cases. In 1947 they had 32 home\n^ confinements. They are supposed to refer to the city health department all pre-natal\ncases. However, they are carrying a few. In 1947 they had 206 patients. It is true\nthat the V.O.N, area comprises most of greater Winnipeg. However, there must have been\na great many of these 206 who were city of Winnipeg. They are supposed to refer to the ,\ncity Health Dept. by phone every month, any who request a visit on return from the\nhospital. They carry these up to six weeks and then discharge them to the city.\nThey have quite a large chronic case load. The largest sihgle group of\nchronics are arthritics. They give a number of injections, insulin, liver, beminal,\n\ allergan, penicillin. For all, but liver, they do not need to have an order written by\nthe doctor. If V.O.N, can give these injections why cannot the Dept. nurses do immuniza-\ntion? Their health education program consists laregely of work with mothers and babies\nup to six weeks of age. They make weekly and weigh the baby and discuss their problems.\nThe V.O.N, do some work with industry and at one industry they go in for two and one-halJ\nhours two days a week. This is only to assist the doctor when he does the tests. This\n^happens to be an industry where there is a hazard of lead poisoning. A second industry\nis to Hudson's Bay House where there are three hundred employees. The nurse goes there\nfor two hours five days a week. This is mainly a health counselling service and assist-\nH| the doctor with pre-employment examinations and re-examinations.\nMiss Robertson, Western Supervisor for the V.O.N, was in the city over the\nweek-end and I had a discussion with her on Sunday morning. She says that they are\nplanning to put V.O.N, into Nanaimo and Moose Jaw. She says the people want the service, j\nWe had quite\" a discussion as to how you measure mm want and need. I do not think the\nVON have any definite survey plan. If they can get their service/%8en they want to.\nI They do not think of the possible wastage of administration and nursing personnel. She\ntold me of the integrated services in Nassau county where the county nurses and visiting ,\nnurses each have their own district and carry a complete service except for the school.\nAt, Gibson's Landing in B.C, the V.O.N, have two nurses doing a completely generalized I\n -121-\n^T^;?* 5h8 ^ P0?*1^1011 is about 4,000. In Lincoln County in Ontario, they\n,are doing an experiment with the V.O.N, working with the county. This should be seen\n+L^?\u00E2\u0080\u009E \u00C2\u00A3 w4^\" *? P\u00C2\u00B0rt William ^ ^a doing quite a bit of pre-natal group\nteaching. The V.O.N, and the city share in the classes. Fo*- pre-natal classes the\nV.0.H. the guide for Maternity Centre and they also use a maternity centre birth atlas.\nThey make use of two films, \"The Training Table\" and one on the birth of the baby. They\ntry to suggest to the nurses that they do not take more than fifteen minutes for the\nactual talking on their part, the rest is discussion. They do as much demonstration as\npossible and the mothers are given an opportunity for individual conference,\nA very interesting morning was spent at the Winnipeg General Hospital. The\nfirst part was in the Hospital Health Service or rather Hospital Social Service Dept.\nwith Miss MacDermott, she is a public health nurse who has had some social work training.\nShe has been in this department some 23 or 27 years. She has two nurses now, neither\nhave public health. Her public health nurses left. They interview all new patients who\nare admitted to the O.P.D. The agencies will have already notified them regarding the\nproblems of their own cases. They refer all pre-natal cases to the city, they refer\nall pediatric and orthopedic cases also. She says that In order to do this work the\nnurse must be able to work with people, must have an interest in people and a working\nknowledge of all other agencies in the community. They urge a contact of their staff\nwith nursing and with social agencies. They handle a considerable amount of material\nrelief. I still feeJL that both this department and the department at the Childrens\nshould not be called Social Service department. There may be a place for the public\nhealth nurse acting as a liaison but we should not say that she is doing social service.\nIn the case of the General, the so-called social service staff are members of the hospital staff, they are not directly under the nursing service, I am not sure that Miss\nPullens agrees with public health nurses doing this work.\nFollowing my interview with Miss McDermott I had a talk with Miss PullenX\nin relation to the integration of the preventive aspects into the teaching program. In\nher curriculum this is outlined. She has very sound ideas and they are, I would think,\nrapidly approaching a central school plan. Several of the hospitals bring their students\nover and ait in on the lectures at the General Hospital, . After lunch I talked with Miss\nMacDonald who is the Educational Director and Miss Whiteford who has just come back after\nstudy and has been acting as a public health nurse and counsellor since July. She has a ;\nmost interesting program. She is going to do a job analysis and job specification and\nsend this on to me. It seemed to me that she was really doing the kind of a job which\na public health nurse should do in a hospital. However, they all agreed that in order\nto do a job such as this, extra preparation beyond the basic public health preparation\nis necessary. This person should fit into the educational department of the hospital\nand therefore needs some preparation in nursing education. All the students of the\nGeneral Hospital spend five days with the city health department and two days with the\nV.O.W. In addition to this, each student visits sorae community agency. She is prepared\nfor thia visit by discussion with Miss Whiteford. When she gods out she knows exactly i\nwhat questions she wants to ask. She then has to write a report on this which is\ndiscussed with Miss Whiteford. I heard Miss Wilson remark on how well prepared the\nstudent is when she comes out for this day with the Health Unit. She knows exactly what\nshe wants and goes about getting it. Miss Wilson remarked also on how mueh assurance\nthe students have from the Winnipeg General Hospital. When they are asked to do something they go right ahead and do it. Sometimes the students from the Catholic hospital\nmight do a more finished job but she does not have the same self assurance.\n -123*-\nPROVINCE b\u00C2\u00A5 QllEBEC\",.\nOn January 17th we started our survey in Quebec. In the morning we went\nto the legislative Building to see Dr. Gregoire. Found that he was out and would\nnot be back until Tuesday afternoon. Dr. Foley, Epidemiologist, was also out. We\nreturned in the afternoon to see him. The following is some of the information which\nI gathered from the discussion.\nThere are 6$ Health Units in Quebec, there is still one to be formed and\nthat is on the Island near Montreal. All the health units have three to seven nurses.\nThere is no senior nurse or supervisors, and there is no Division of Nursing in the\nprovince. They have in all, about 250.nurses in the health unit, of these, I think\nonly four or five have had public health training. In addition there are sorae 180\nnurses in the medical services. These nurses serve the parts of the province where\nthere are no doctors and I believe they are under a separate division. I am sure\nthere are no public health nurses in this group. All the units have one or more\ndoctors. The nurses are paid $1,300 to 1,640 (later information discounted this, as\nin Montraagny the nurses there are receiving $1,200) it does not make any difference\nhow long they have been on. Miss Mercier told me that you might be on twelve years\nbefore you would receive $1,500. On the other hand if you are on the political\nappointment, you may be appointed at a larger sura right away. She is a health educator and she receives $1,200. She has her public health and in addition she has some\ntraining in health education, all taken at her own expense.\nA nurse was appointed to the unit about two months ago without any training\nShe is receiving $1,200. There are two other health educators, one of whom has not\nher public health training and is receiving $1,500. This is the way politics works\nin tills province. Cars are not provided, the nurses have to buy them. There is an\nallowance of $350 per year plus five cents a mile.\nEventually they plan to have two to four units in a district and then they\nwill have a senior nurse. They also plan to have a division of nursing in one and a\nhalf years to two years. Dr. Foley said the main work in the unit is health education, school,immunization, child welfare. Not more than 25% of the confinements of\nthe whole province, including Montreal, are in hospital. There are nine sanatoriums,\nnone of which As owned by the government, but they are government subsidized. In\naddition to the nine sanatoriums there are several units in general hospitals but\nthese are not very satisfactory. They are planning a B.C.G. campaign for the newborn\nup and I think they are planning to put a special nurse in each unit for this. There\nis no public health nursing course at Laval. On the Q.T., Dr. Foley said they have\nalways been dissatisfied with the course at MontreAl University and they are now\nplanning a re-organization of it.\n -*23-\nQUEBSC CITY\nIt has been suggested by Dr. Gilbert that while we were in Quebec we should\nsee something of the city set-up. Dr. Paquet is in charge, he has six graduate\nnurses, none with public health, and four auxiliary workers. One of the graduate\nnurses is now taking her public health in Montreal and he said that three of the\n\"JS ^uu\u00E2\u0084\u00A2 TOre i:L1 SO that he only had two on when we were there. Dr. Pawuet\nsaid the he was only the medical officer for the city and that is, in effect, all\nthat he is. He does not do any school examinations, he has the city hospital for\ncommunicable diseases and he does immunizations in his office. We could not find\nout what else he did. Dr. Baillie saw him very briefly on one afternoon and did not\nreturn to see him again. I went out with one of the nurses, Mrs. Bureau and from her I\nin conversation and observation, I gleaned the following.\nThe city nurses do only school work and follow-up from the schools for\ncommunicable disease. They also assist the doctor in the City Hall with immunisations. It seems that the auxiliary workers do much the same as the graduate nurses\nexcept that they do not do the home visiting. The work in the school consists of a\nso-called examination, a visit to the homes for absentees who have been awajfy three\ndays and for diphtheria and scarlet fever. That, in effect, is communicable disease\ncontrol also. If the so-called examination is as I saw Miss Bufreau doing it, it is\nextremely superficial. She had in four children at a time. She talked to them and\nasked them a few questions about how long they had slept, what they had for breakfast,\netc. She looked at their teeth and their throat, felt their glands. There was no\nrolling up of sleeves or looking at chests or examination of feet or heads, except a\ncursory glance. The school I visited with her was a college. The colleges are for\nboys and the convents for girls. This college had 22 classes. We went to all the\nclasses on the lower floor with the absentee list. The children all stood when Miss\nBu#reau went in, she asked them to show their hands and did a little talking, this !\napparently is what happens every morning. She did not go down the i\u00C2\u00B1 aisles to see\nthe hands but remarked on how clean the hands were. In one class she had them show\ntheir teeth and remarked how clean the teeth were. My guess is that 90% had not seen\na tooth brush for sorae time. In the room there were all double seats and the lighting was extremely poor. On the whole however, the children, from a distance, did\nappear adequately dressed and fairly clean. I noticed two children with quite marked\nstrabismus. There was just a shrug of the shoulders, these were from very poor\nfamilies of eleven children and fifteen children respectively and what could one do.\nThere was also a child who came up for examination who was twelve years old and in\nGrade I. Miss Bureau said there were 23 such children and there were no special\nclasses. She does not test for eyes or ears. When I questioned about the vision \u00E2\u0096\u00A0>\nshe did following that, ask the children if they had to hold their books close or far\naway and if they had difficulty seeing the board. She said that kkxtx she felt that\nthe observation of the teachers was the most important thing. She has a fundamental\npoint there, but these teachers are certainly not qualified or did they strike me as i\npeople who did look for that sort of thing. The one boy with strabismus was not near\nthe front of the room. There is a great deal of clerical work, all the reports (see\nIn file) are done by the nurses, annual report and all. There are individual cards\nfor each child, but she does not use these at the time of the examination. The\ninformation is copies from a slip onto these at the end of the year. The teachers\ndo not take any part in the sorting of cards or anything like that. Miss Bureau\nsays that she had five schools - a total of over 2200 children. She visits one\nschool each day. Last week She made 14 home visits, took 44 swabs, she spent two\nafternoons at the City Hall and she went to her five schools.\nThe second afternoon, Dr. Baillie and I visited the St. Saviour orphanage\nin lower town where one of the fourteen clinics of La Gute De Lait was being held.\nThis is the organization which does the child welfare. It is a voluntary agency and\nthey take infants from birth to two years. There is no agency in Quebec for the\n&Zr\n -124-\npreschool age child. There are seven nurses and one superintendent in this agency.\nThere are two nurses in each of the fourteen clinics and all with a doctor. As far\nas 1 could observe the nurses simply wiefcfc and measure the baby and do the clerical\nwork. The doctor does all the consulting. The doctor does not make any examination\nunless requested. A nurse told me that they visit all the babies, the name is taken\nfrom the baptism list. If they do not come to the clinic they do not visitagain or\nfollow up. They tu ?!? h8Ve not *\u00C2\u00BB* cauSht ^ 'ith them to obtain their registration\nor more likely i^at they are not qualified for registration. Accorddng to their\nfigures in W7 there were 1022 nurses in public health in Quebec. 751 of these were\nFrench and 271 English (See blue report of the R.N.A.P.Q. for further information.)\nMETROPOLITAN LIFE INSUXRANCE\nOn the morning of February 3rd I visited Miss Rocque who is the provincial\nsupervisor for the Metropolitan Life. Of a total of sixty-seven nurses in Canada,\nonly two are outside Quebec. One in Glace Bay, already visted and one in Sudbury. In\nMontreal there are 41 nurses. Miss Cantin is the educational director for the Montreal\nservices, unfortunately, I was not able to discuss her program with her. This is the\nchief centre for the visiting nurse experience for the studeAAs at the Montreal\nUniversity. In Montreal there are three district offices acrabd&xaHXSKxy Quebec city\nhas 13 nurses. There are twelve other centres throughout the province. According to\nMiss Rowque the following is the program.\n1. Bedside care to policy holders and teaching along with this care. They do not have\nany delivery service. The V.O.N, is under contract for the English speaking policy\nholders. They will refer the infants to the baby clinic if the doctor approves.\n2. The teaching centre is for new nurses and for students from the university. The\nnew nurses spend about six weeks in the Centre and then this orientation period is\nfollowed by participation under supervision. Each centre in Montreal has a teaching\nnurse in addition to the supervisor and head nurse. The head nurse is really the\nassistant supervisor. All the supervisors, head nurses and teaching nurses are public\nhealth. Only 13 in the whole of the Metropolitan Life group are not public health\ntrained. The maximum salary for public health is $185 and the starting salary $160.\nThe nurse working alone gets $10 more. The above figure of 13 was for Montreal alone,\nand outside of Montreal there are only four nurses without public health and none of\nthese are working in the area by themselves. (Correction) In Montreal there are only\nnine without public health. Therefore the total in Metropolitan without public health\nis 13. I was sorry not to be able to visit in the district with the M.L.I, nurses.\nI missed seeing Miss Garrard in Montreal but will see her in Ottawa and perhaps get\nmore accurate information and will also try to get information as to their plan.\nAccording to Miss Rocque, the M.L.I, are having to retrench as far as expenses are\nconcerned. It seemed to me that their overhead in nursing was rather high.\n -131-\nMONTREAL CITY\nA. Department of Health,. The following information is supplementary to the outline.\nMy first contact was with Dr. Groulx. He gave us a lot of bulletins and a series of '\nradio lectures which he had given. I was interested to note that this series was on\npublic health nursing, yet no nurse was called in to help prepare or to give the\nlectures. Typical of the French doctor and I guess of the French man. As Miss Geroux\nsays the biggest thing they have to overcome is the Latin complex or rather the Latin\nblock.\nThe second morning I met with the three assistant directors of nursing.\nMiss Roy has recently retired as Director of Nursing and no one has been named as\nacting director or director, as a matter of fact, there is not a Division of Nursing , !\nit is a section of the Division of Health districts. The three assistant directors\nare Miss Ritchie, Miss Laliberte and Miss Martineau. There is a considerable amount\nof speculation and bad feeling about who is to be named the chief. Miss Laliberte\nassumes that she will, and almost acts in that capacity now. Miss Martineau is bitterly disappointed because she fears that she is not going to be named. Miss Ritchie,\nknowing that she will not be and not wanting it anyway, sits on the side lines. They\ntold me that their greatest problems are the preparation of personnel and it is very\ndifficult to get prepared bi-lingual nurses. Another problem is the lack of educational direction. A third is the lack of time for orientation. They have to put the\nnurse right on the district when they get them. A fourth is that their supervisors\nare not too well trained and they have too heavy a supervisory load. They have no\ntraining centre and they feel that this is a very great lack.\nThey feel that the salaries are very low. During the time I was in Montreal\nit was announced in the paper that the nurses were going to have an increase. I\nthink this would be a minimum of $1920 and a maximum of $2400, although I am not sure\nof this. At any rate, the only notification that the nurses have had is what appeared\nin the paper. The supervisors were very disturbed because thece had been no move to\nincrease their salary and as it stands at present, the supervisor is receiving only\n$20 a year raore than the maximum received by the senior staff nurses. They naturally\ndo not like this. I pointed out to them however, that there is one thing they must\ntake into consideration in comparing their salaries with the salaries in other places, I\nthe uniforms are supplied by the city and replacement are also supplied by the city,\nincluding coat and hat. They get a felt hat once a year and a new spring hat every\ntwo years. This As a very gener/ous allotment.\nOne great disadvantage is that the office of the three assistants and\npresumably for the director too, when she is appointed, is so far removed from the\ncity hall where the central offices and all the administrative medical staff are\nlocated. There are eight district offices. I visited one of these at Maissoneauve\nwhere Miss Olivier is in charge. She has eighteen nurses in the district of which\nten have public health. In addition there is one dental nurse. Two of her eighteen\nshe uses as floaters. Last week she had five nurses absent and of course, she had to\ndo a lot of filling in herself. The supervisees are going to make a list for me\ninstead of the job analysis of all the things they do which are not supervisory. In |\nMaidsoneuve district there are nine baby clinic centres. I think this is the only\ndistrict where they have nurses' sessions. In all the baby clinics which I observed\nboth here and in other districts there are usually two nurses, sometimes three. One\nnurse weighs and measures the baby. The other nurse stands and takes the baby into\nthe doctor and greets the mother and returns when she comes /out. A third nurse\nwill take the next mother and baby in, etc. They supposedly have conferences but it\nis lust standing at the table when the mother is dressing the baby and the nurse may\nor may not go over the instructions which the doctor has given, in case the mother\ndoes not understand. It seems hard to get over the idea of a really separate conference!] |\nwhan the mother is sitting down and the nurse talking to her or with her. They all\n -132-\nmeasure the baby - why, no one could tell me. In the clinics there are no volunteers.\nDr. Uroulx had an unfortunate experience two or three years ago apparently, where\nvolunteers sued for pay and he has definitely stated there will be no more volunteers.\nCertainly a great deal of nursing time is wasted in this respect.\nThe greater proportion of the nurses' time is spent in the schools. I\nvisted one school^, Victoria, and the nurse is doing some work with the teachers and\nwith a special teacher's record drawn up on the Nyswander program. Victoria school\nhas around 460 pupils. The principal is Mr. Fyles, and he is extremely interested in\nthe health program. It is absolutely essential to have a principal who is cooperative\nbefore anything like this can be undertaken. Miss Dorian is at this school every\nmorning, she also does visiting in the morning. She has two other schools each of\nwhich is about half the size of this one and also a nursery school. She has two j\nafternoon clinics a week. At the first of the year in the school, the children are\nweighed by the teacher with the help of the principal. That is what has been done in\nprevious years, but this year apparently they were too busy so the nurse had to do\nthe weighing with the teachers help. The children are weighed a second time. The\nnurse does this herself. For the past three years she has been teaching the teachers\nto do the vision testing and hdpes they will all be able to do them on their own next\nyear. She finds the teachers are much more conscious of the vision of the pupils if\nthey do them. The vision testing is done onee a year. She makes a class room inspection two times a year. This is quite a thorough inspection. When she goes into the\nclass she speaks to the pupils and has the children come up one by one, she looks at\nthem for cleanliness, looks at their teeth etc. She sends a letter home to all with\ndenial caries. She checks their general appearance, she picks out the children for\nthe doctor at this time. She has this individual contact with each child which she\nfeels is very valuable. At the end she speaks ws she speaks to the whole class.\nThis procedure takes about one hour. The doctor examines all the kindergarten and\nall in Grade I who are new to the school. The mothers of these pupils are invited.\nThe doctor then examines the children in Grades 3, 5, and 7. In another school which\nI visited, the nurse said that they did their examination on the family basis, for\ninstance, they .started out with, the pupil in Grade I, but all the rest of the children '\nof that particular family would be examined at the same time with the mother present.\nIn the high school, the doctor examines Grade 8 as new pupils to the school. This is\na repetition as they presumably were done in Grade 7 in the elementary school.\nActually, all that the doctor gets done are the kindergartens, new pupils in Grade I\nand Grade 7 and referrals from the other grades by the nurse. At The nurse has a\nconference with the teacher on each pupil in the class, some time following the\ninspection and if possible, before the doctor's examination. The doctor usually\nexamines all those specially picked out by the nurse and the teacher at this time.\nThe teaeher has her card which she has filled in. These cards have been in use for\nthree years and now it is beginning to work and the nurse feels that it helps to keep .\nthe teacher interested.\nIn most of the schools I visited the nurse says that only those who are\nabdent because of illness are reported. The teacher attempts to find out why the\nchild is absent. In the schools the nurses seem to be getting the teachers to do\nquite a bit of the health work and they are endeavoring to act in the capacity of\npublic health nursing consultants. I am not sure to what extent this is actually\ndone but at least the answers were given to indicate that that was their program.\nChild Welfare - As indicated in the remarks above the chief child welfare load is\ncarried throu^i the clinics, of which there are great many and at most of which a\ndoctor is present. I did not feel that there was very much real teaching done by\nthe nurses, it is chiefly a weighing clinic and a doctors clinic. Birth registration\nnotices are obtained and all new babies are visited by the nurses.\n -133-\nPre-natal ~ ihere are pre-natal clinics in the health districts at which a doctor is\npresent. I did not observe any of these clinics but I question the health teaching.\nI do not think there are any definitely planned pre-natal visits made in the home. If\nthey happen to contact a mother who is pregnant they refer her to the pre-natal clinics,\nThere is an attempt made at pre-natal classes, these I did not observe. In addition\nto the Health Dept. pre-natal clinics, the Royal Victoria hospital has pre-natal\nclinics throughout the city. There is however, no home follow-up of these.\nContagious diseases - I found that each nurse has her own school districts and also a\ncontagious disease district. These may not necessarily coincide and the nurse may\nfind herself visiting in a home for contagious diseases and the children in this home\nattend another school. That is, of course, because of the French schools and the\nEnglish schools and the Catholic schools and the Protestant schools. Religion certainly\ncomplicates the problem in this city. The nurse is supposed to make a visit to every\ncontagious disease and fill out the special epidemiological form. If, even the disease\nhas been reported by a family doctor she must make this visit. Sometimes the disease\nwill have been confirmed in the school by the medical health officer, she still has\nto make a visit. If it is a school/ child she has to return to give a certificate of\nrelease. If it so happens that the child does attend her school she can have the child\ncome to school for this certificate. However, this does not happen very frequently.\nThe work of the nurse in the district then, is chiefly, school, contagious disease and\nbaby clinic. i\nTuberculosis - there is a special staff of nurses for the tuberculftsis work in the City\nHealth Dept. This is headed Dr. Le tt\u00E2\u0080\u0094\u00E2\u0096\u00A0\u00E2\u0096\u00A0\u00C2\u00BB Douceur and an assistant director. The\ndupervising nurse is Miss Dessault, she has seven nurses of which three have had public\nhealth. I do not think Miss Dessault herself had had public health. These nurses\nare responsible for finding the cases for the city or rather this centre is responsible\nfor case finding for the city. They give an x-ray but do not do any clinical examinations. It is supposed to be an auxiliar service for the private doctors. They do\nhowever, do gastric tests, and sedimentation. They interview all patients. It there\nis a social problem they call on the other agencies as they have no social worker of\ntheir own. All cases are registered with the Saxacft Social Index. The nurses do the\nfollow-up in the home. They also do the clinic work. There is one night clinic a ,\nweek. I question very much that there is any very intensive \u00E2\u0080\u0094Eni* follow-up work .,\nin the home because of the distances they have to travel and the number of clinics\nthey have to attend. There seems to be quite a close working relationship and clearance with the Royal Edward Institute which is the English organization for T.B. and\nthe Bruchesi Institute which is the French organization corresponding to the Royal\nEdward. i;\nI visited the Royal Edward Institute and talked with Miss Harris who is the .\nsupervisor of the nurses. This Institute has a clinic and also about a fifty bed\nhospital. It was started in 1914 and is a private organization and is not under\nCommunity Chest. There are fifteen nurses and one supervisor for the district. Five\nof these have not had public health. The 350 beds at St.e Agathe are related to the\nRoyal Edward Institute. In Montreal they have a clinic, they cover the city and the\nsurrounding municipalities. Four of the fifteen nurses are in the clinic all the time.\nOne admission nurse is non-public health, one nurse who takes the temperature and E\nweighs is non-public health, another takes the histories of new patients and the fourth\nwho is not public health, is part-time in charge of the pneumo. Theyxmayx remainder\nto district work and a certain amount of clinic work, for instance, on Saturday\nmorning there is a children's clinic and they have two evening clinics for adults.\nThey have about one hundred known positive sputum cases in the homes. Their case load j\nis 250 to 350 families per nurse, the average is about 300. At the present there are i\nno cars but they hope to have a cartf provided and a chauffeur. Social work is referred\nto agencies. ihey do need a medical social work consultant. Miss Harris seemed to\nthink that there would come a time when the work of the Royal Edward district nurses I\nwould be taken over by the city. However, it seemed to me that this is rather\n -134-\nn?t^\u00C2\u00A3; Ldilh8ar 2\u00C2\u00B0\" !u\u00C2\u00B0th6r SOWCCe that **\u00E2\u0080\u00A2*\u00E2\u0080\u00A2 ia * Plan for a rotating service\n?L?^f \t ^er/ords> thww wouM *a one nurse in charge of the whole Institute,\nincluding the beds for major surgery and the d^trix nurses will rotate on the\nservices. This would be a very good plan and/l|!proach in a specialized way, to the\nhospital as a community health centre. The Bruchesi Institute is apparently operated\nin much the same lines as the Royal Edward and I think they have a much larger staff\nof nurses, possibly around fifty. I did not visit this Institute.\nVenereal Disease Division\nAs indicated previously, the V.D. work for the city is done by the Provincial Dept.\nThere is however, a division at the City Hall headed by Dr. Dussault. He has two\nnurses, Miss Provost who has just gone to Philadelphia for a three month's course and\nMiss Roy, Bothp of these nurses have had public health. This division is two years ry\nold,they do not have any municipal clinics. The control of V.D. is the responsibility 5\nof the province according to the Act. The duties of the nurses are as follows -\n1. .Daily interviews with those coming to the office\n2. Referrals to clinics or private doctors i\n3. Open file on all cases.\n4. Report all cases to province .1\n5. Get from clinic all information necessary to complete file\n6. Traces all cases brought to their attention by miniztmxs the Ministry of Health.\nThese may be cases whom they cannot find. te\n7. Arrange all appointments\n8. Call at home or place of work to get contacts '\n9. Follow up of delinquents.\nm\nIn 1948 there were 640 interviews. They average 20 minutes per interview. y\n10. Sometimes take patients to the clinics,\n11. Take blood sample\n12. Give information to the nurses in training for the public health nursing course\n13. Available for lectures\nMontreal has 3/,% of the population of Quebec and 70% of the V.D. problem.\n\"Hiis division is in effect, a liaison between the City Health and the Provincial\nDivision. They get their cases chiefly from those comigg up for health cards and all\nthese cases who are positive, must be followed up and complete information kept in\ntheir files. These are mostly the people whom they interview. They also do liaison\nwork with the provincial department and the municipal police*\nMental Hygiene - This is Miss Laliberte's department as she has been specially trained -\nin mental hygiene. There are eight nurses. 75% of their time is taken up in intelligence testing. In the schools the grouptesting is done by the Education Dept.\nsupervisor and all the group, those that are very much below or above are tested\nindividually by this nurse, psycho-technician. They also test the problem children.\nThe xpjcrici psychiatrist will also give intelligence tests and he makes recommendations j\nWhen they finish a school they have a conference with the teachers and principals\nand the school nurse. Each of these eight nurses has a clinic at the Centre and she\nbrings her problem cases in to see the psychiatrist. Sometimes this nurse-technician\ngoes to the home, but sometimes the school nurse goes. They have a full time psychiatrist and a part-time psychiatrist and they are getting two psychologists. The\npsychologists will give psychotherapy. Usually this nurse psycho-technician does the\nfollow-up in the homes. Their work is almost all with school children and there are\na few pre-schools. They seen to like this work very touch and admitted that, although\nthey spend about 60 to 75% of their time in tfcm testing, they do not think their\nnurses training is wasted. In talking with Miss Laliberte afterwards she said\n -135-\nshe hopes to use some of these nurses, all of whom have had public health in the\nvarious districts and helping with in-service training in mental hygiene. It seems\nto me that she could have done a whole lot more on this program to date than she\nalready has. The French idea df teaching is doing by telling.\nThe Mental Hygiene Institute is a part of McGill University and is a\ndiagnostic and treatment clinic. They usually take only referred cases and those\naoaaxgenerally referred by agencies.\nB. Related French Agencies\nThese seem to be legion. All seem to have separate boards and are all very\njealous of each other. There definitely should be sorae amalgamation. I visited the\nfollowing -\n1. Parochial well-baby clinics or Gouttes de Lait. Miss Gosselin is in charge of\nthis and she took me to one of her clinics, no doubt, one of the best. They have\n28 centres. Some of these are open two or three times a week. There are 11 nurses\nof whom two have had public health, and 19 auxiliaries, who weigh the babies and pull\nthe records. The nurses visit in the homes, they visit all born in their district.\nThe clinic which I observed was in one of the parish institutions. They had very '\ngood accommodation, 27 mothers attended this clinic, all of whom saw the doctor. The\nnurse weighed the babies. There was no conference with the nurse. The babies come\nevery two weeks up to two years. After two years, every month. WhenI questined\nthis they did say some came less frequently. In the home the nurse gives general\ninstruction and sometimes gives a demonstration bath. The nurses wear a blue uniform\nwith a white collar which is very attractive, these are supplied by the agency. They\ntold me that very few moSieSs nurse their babies.\n2. Association des Infermieres Visetues. The nurse in charge is Miss Latour who is\nhuge and I am sure could not do any work on the district herself. She has twelve\nnurses, none of whom have public health. There is one in training at the university\nnow. Ihey serve the city of Montreal and have been in existence ten years. Their\nprogram is bedside nursing. Their chronic case load is the heaviest. There were\n1500 to 2000 visits last year. The chief type of chronic is the cancer and the\narthritic. They also give injections for liver, vitamin B, Insul/in, etc. They\ndo pre-natal work but they take only those who can pay. The poorer cases are taken\nby Assistance Fraternal (see later). They charge $1.00 to $2.50 per visit for the\npost-natal. During the pre-natal visits no charge is made. They do not give any\nhome delivery service as they say the doctor usually has his own nurse. After the\nbirth of the baby they go in once a day for eight to ten days. They give a demonstration bath. It seems to me there is very little pre-natal health supervision. There\nwere 1136 visits made in January and only 11 nurses. The nurses come into the office\nonce a week, Tuesday afternoon. Otherwise they go to work from their homes and do\nnot contact the office except by phone. About one-third of their time is spent on\ntravel. They are a Catholic agency and do take English catholics. The V.O.N, turn\nover all their catholic cases to them. I learned later from Miss Laliberte that the\nchairman of this Board told Miss Latour that she should not have given permission\nfor me to visit the agency.\n3. Assistance Maternal. This is another private agency which does visiting nursing\nfor pre-natal, maternity only and goes to those who are too poor to pay or those\nthat do not wish to go to the Visiting Nurse Association. The nurse/ in charge is\nMiss Ouellet, she has sixteen nurses, one of whom has had public health. However,\ntwo of the sixteen are not graduates. Miss Oueldet had her public health in Montreal (\nin 1944. At their Centre which is a very nice old house, they have two clinics a\nweek for pre-natals. Pre-natals come here once a month, there Are three doctors at\neach clinic and they have about 40 mothers. The nurses visit in the homes of the\n -136-\npre-natals once a month and they attend the confinements. Following the confinement\nthey go in every day for ten days and again in one month when they close the case.\niney give a twenty-four hour service. None-graduates do not go out, one stays on at '\nnight and the other is on in the day helping with layettes. At the pre-natal visit to\nthe home the nurses take the temperature, but do not take blood pressure. The blood\npressure, urinalysis and Wasserman is done at the clinic. In 1947 there were 1139 >\npre-natals of which 777 were confined at home. There were 62 infant dearths, and 6\nmaternal deaths. They have made 13,15$ visits. The public health nurses are paid $140\nper month; non-public health $135; non-graduates $125. The part-time secretary is paid\nat the rate of $150 per month. It is very evident that the nurses like this kind of i\nwork or they would not stay at a pay which is much lower than that of the city nurses.\nA purple two piece uniform is provided,\nC, Victorian Order of Nurses >\nThe staff of the Victorian Order of Nurses in Montreal consists of a District\nSuperintendent, Assistant Superintendent, Educational Director, and 46 nurses. These '\n46 include the five district supervisors in the five districts. Of the 46 nurses, 30\nhave had public health. They hope to have a total of 50 nurses in district work. The\nprogram consits of bedside nursing in the homes and they have one industry to which thej\ngive one period of two hours per week. In this industry they assist with the medical\nexaminations and follow-up and health counselling service. There is also a home visiting service for this industry. In 1948 they had 905 per-natal patients. They attended\n63 home deliveries. 806 new obstetrical cases were admitted on return from hospital.\nTheir pre-natal cases are referred from St. Mary's and the Homeopathic Hospitals and\nsome from private doctors. They fell that their pre-natal program is very weak. There\nare no pre-natal classes. They do post-natal work on call and follow-up for six weeks. I\nThere is no exchange or referral slips. On the staff they have a physiotherapist who\nhas been with them since March 1st* She is an adjunct to the nursing service. At the 1\npresent time she has 23 cases to whom she is giving physiotherapy. 13 of these cases\nare for physiotherapy only and ten are getting physiotherapy and nursing care. The\ntype of cases referred are hemaplegias who are referred almost immediately, arthritics\nand fraetures. *Rie nurses have been made aware of the application of orthopaedic\nprinciples to nursing. They do not do any actual physiotherapy as I had understood\npreviously.\nMiss Weatherhead is in charge of the educational program. They have undergraduates from the Royal Victoria, Homeopathic, Montreal General and St. Mary's.\nEach student* has one week. Almost all the students obtain this except those from the\nRoyal Victoria. They have post graduate students from McGill, each student has one\nmonth block field work. Each has a guide nurse and they have independent work. Miss\nWeatherhead is responsible for the orientation program for new nurses and for the staff\neducation program for the staff. She attends the monthly conferences in the centres\nand she arranges for four large staff conferences of the whole group together.\nD. Child Health Association E\nI spent one day with this Association which is directed by Miss Deeth and ther\nsome further time with Miss Kennedy who is a consultant in mental hygiene. Miss Deeth\nis\" assisted by Miss Milligan who is in charge of the Health Service aspect. Miss Cook j\nis in charge of the Chandler Centre where the educational work is done. Miss May is \\nin charge of the Rosemount area and I think Miss Kennedy has a district also. In 1921\nthe Child Welfare Association affiliated with the baby centres. Since 1948 it has been\ncalled the Child Health Association. From 1921 to 1948 it was the Child Welfare. It j\nis supported by Community Chest grants, Grants from the province, the city of Verdun,\ncity of Montreal and the Federation of Catholic Charities. There are fifteen public\n health nurses and a director, one consultant in mental hygiene. Four of the fifteen\nare supervisors. They have 47 part-time physicians. The medical staff are on the\nmedical or teaching staff of the university. This very important and it is used as '\na teaching centre for this university and probably will always be continued as such.\nTheir responsibility as a demonstration agency is to maintain a high standard of\nservice. They have research projects under way. They have been doing one on Lederle's\ntri-emenol. They are doing one on inherited immunity and they are following up last\nyear's study on the use of multiple antigens. (See the report in the C.M.A.J. Aug./48)\nThere are two divisions to their work, (l) The Child Health Centre Division\nwhich is a family service from birth to school age, and includes the whole family.\nIt provides an educational health service both from the medical and nursing apects.\nThere are three areas in Montreal and Verdun, serving the English speaking and foreign ;\npopulation. All the English hospitals refer all their public ward discharges to the\nAssociation. The total population of the district served is 180,000. of which 75,000 \u00E2\u0096\u00A0'\nare non-French. Therefore, this Association iii\u00C2\u00ABmt.i\u00C2\u00AB\u00C2\u00AB direct/fs its services to a !\npopulation of 70,000. (2) Health Services Division. This was established in 1930\nas a result of a survey of health services of the various social agencies in Welfare *\nFederation. They provide a coordinated health service for all the agencies^ The\nFamily Welfare has an association and a clinic is established within their set-up.\nA social worker is present and she has direct access and is with the physician. In\nthe Settlements they do adult work. In this they get all the social problems of the\ncommunity right back to the physician. The nurse gives the health teaching, they give\nthis service to all age groups. The Foster-home children have special clinics. The\nnursing staff of the agencies, of which there are four nurses, meet with the child\nhealth association staff. They do Foster homes and receiving homes. The medical staff\nis under the direction of the Child Health Association medical director, who Is Dr.\nFleming. The volunteer services are under the direction of two members of the board.\nThey are experimenting with records and they are trying to develop a narrative record.\nChild Health Service Division - Those eligible for service are infants and pre-school\nchildren in families living within the boundaries and not under supervision of a\nfamily physician. They pay a family membership of $1.00 to $10.00 based on income.\nThis includes everything for the family, physical examination for the mother, h\u00C2\u00B1k.\nx-ray, etc., but no dental service. The babies make four contacts with the physicians\nin the first year - on admission, at three months, at six months and at ten to twelve\nmonths. Future contacts as necessary up to six years. Six to forty-five years , once\nin three years, over forty-five years, yearly. They give immunizations at the clinics.\nEvery family that is under supervision must be visited in the home to know the home\nconditions. Once in six months, at least, the frequency is based on the need. There\nis a definite plan for every home visit with a definite purpose in view. There is\ngroup teaching. There is a nutrition consultant sometimes in the child health centre. \u00E2\u0096\u00A0\nThey did experimmnt with volunteers for visiting in the home, the purpose was to extend\nthe service in the homes through additional visits and interpret the Association\nservice to the volunteers and to interpret the health needs of the community to the\nvolunteers. The reaction of the family was very good. It provides an outlet for the i,\nmother - someone who has time to sit down and hear her talk. They are not able to\nhave this volunteer visiting service now because they cannot get the volunteers who\ncan leave home themselves. They cannot get baby-sitters. The nurses are paid $1920\nto $2100. They have a five-day week and no uniforms. There is a very good manual.\nEvery nurse takes students, they have a weekly conference of staff and supervisors\nand a routine supervisor's meeting the first and third Friday mornings and a monthly\nmeeting of the whole staff. They have a nurses council.\nIn the afternoon I visited Chandler Centre and observed the nurses conferencing with the mothers and the doctofs examination. Each nurse has her own clinic\n -138-\nand the mothers referred are from her district.\n1* Family Welfare Association - I did not visit the Association but talked with\nEleanor Barnstead one evening. She is the case work supervisor. They have about 50\nworkers and they do more than the family service as they take in single men and women.\nThey have a visiting housekeeper service, I think about 25 visiting housekeepers under\nthe supervision of a social worker, they would like to have raore. They provide this\nservice for long term cases. She mentioned one family which has had a visiting housekeeper for ten years.\nF. Medical Social Work - at Montreal General Hospital I talked with Miss Tennant about\nthe medical social work department. They take only cases referred by the doctors and\nnurses. Miss Tennant is most anxious to do something with student nurses but as yet\nhas not been asked about it. Just the other day, at the request of the doctor in\ncharge, she told the internes about the service. She was very pleased to have this\nopportunity and very pleased that it was requested by the doctor.\n CIVIL SERVICE HEALTH DIVISION- OTTAWA\nm^wV *\u00C2\u00B0ference with Miss Percy in Toronto on February 19th I visited the\nDivision in Ottawa on February 25th and Feb. 28th. The stated objective of the Civil\nbervice Health Division is to provide a three-fold health service for all government\nemployees. This includes -\n1. Preventive service,\n2. Diagnostic and advisory facilities\n3. Treatment service.\nThe personnel of the Division includes Dr. Ratz, Dr. Davey, a psychiatrist\na psychologist, Miss Percy as chief supervisor of nurses, Miss Gordon, Asst. Supervisor\nof nurses and Miss Hyndman, Welfare supervisor. They have 25 nursing counsellors. Of\nthese 25, two have a degree; ten others have public health certificates and there are\n13 without public health. The work in the various buildings in Ottawa is divided into\nunits. There are five units having one nurse in each, five units with two nurses in\neach and three units having three nurses in each. The extra nurse is away on post\ngraduate work.\nTo me the most outstanding points in relation to this service was\n1. The Relationship with welfare\n2. That they hope to have only four to five hundred peeple per nursing counsellor and\nthat they consider about ten conferences a day as many as a nurse can handle.\n3. The in-service training program\n4. How much responsibility Is invested in the nursing counsellor for all aspects of\nthe service.\nL\nWith respect with the relationship with welfare, Miss Hyndman is in the same |\ncategory as Miss Percy and when the division was set up it was anticipated that she\nwould have a group of social workers but as it has developed, she is really the welfare fi.\ncounsellor helping Miss Percy and the others at the supervisory and administrative\nlevel. \u00C2\u00AB?hMK\u00C2\u00BBiig\u00C2\u00BBiiiti\u00C2\u00BBxgMM|w\u00C2\u00AB\u00C2\u00ABitt^wirg\u00C2\u00ABinf\u00C2\u00ABr\u00C2\u00BBVrttw\u00C2\u00ABBr integrate the welfare aspects into the\nwhole program. The nurse is responsible for all these aspects on her level with the % .\npatient. In other words, when the patient he sacms may come for first aid or some sraal]\nthing and the nurse takes the opportunity of finding if there are any other problems.\nIf there is something which might be referred to a community agency she does so. If\nit is a case of a referral to a family doctor she also does this. It is only when she\ndoes not know how to handle a case or when she feels that the employee should see the\ndoctors on the staff that she will refer them through to the administrative group.\nMiss Hyndman has worked in preparation of a manual, listing all the community facilities and resources in Ottawa. This has been of very great help. She has also assisted\nin designing a folder or record which combines both the health and the welfare and she \u00E2\u0080\u00A2\ntakes part in the in-service training.\nThey plan to have a ratio of one Jutxxaiaa xH*kswsxkaxf nurse to five to seven\nhundred employees. They have found from experience that if there are over seven\nhundred that- the work suffers. Fifteen interviews a day are as many as a nurse can\ndo well. All patients are given an initial interview. All return*to work people are\nseen. This type of thing could easily become a rubber stamp, but the nurses have\nfound that it is one of the best ways of making friendly contacts and finding cases.\n42% of the interviews recently have been return to work. In area which I visited\nthere are three nurses, 1500 hundred employees. Since September they have had //\n5,500 interviews which means about 1,100 per month. The personnel officers in this\nbuilding are very cooperative and this a means a very great deal to the work of the\nnurse.\nThe in-service training program is very well organized. They have ameeting ff|\nof all the staff for li hours during the week and then there is a further meeting\n -140-\nwith the doctors and the nurses separate of another l\u00C2\u00A3 hours. The nurses have worked\ntogether on policies, etc., and this has created a very fine morale, of course it must\nbe stated that the salaries are relatively good in comparison to other public health\nnursing positions. All the nurses with whom I talked seemed to be very keen on the\nservice. They feel one of the big satisfactions in it is that the people are coming to\nthem for something and this is much more satisfying than when they have to go out to\nthe people as in the district.\nI was very impressed with the amount of leeway which each nursing counsellor\nhas. Dr. Ratz feels that the central staff provides a counselling background and that\nthe nursing counsellor is the key pin in the whole service. This certainly seems to be\nwhat is working out in practice and with the close supervision and in-service training\nI am sure there is not any abuse.\nI was wondering how the advantages of a counselling service and the staff i\neducation could be carried out among industrial nurses in the ordinary community. The 1\nonly solution I can see is such as the following -\nIf a city health department would have one of their health officers act as an industrial\nconsultant, this might only be a part time job, and have a full time industrial nursing\nconsultant, then there would be an opportunity to give this needed stimulus and guidance\nto the nurses who are working in industry within the area of that department. As in\nthe Civil Service Health Division not all the nurses, or even the majority of them are\npublic health trained but nevertheless they are carrying on a very effective service.\nThe same holds true in the community. Relatively few of the nurses are public health \u00E2\u0080\u00A2\ntrained but lacking the guidance from a consultant or consultant staff, the program is\nvery weak in most places.\nLECTURE BY DR. BIXLER ;\nHOW WE CAN SOLVE OUR NURSING PROBLEMS MORE EFFECTIVELY\nI\nWB must give consideration to those things which compel us to make an effect- \u00C2\u00BB\nive study.\n1. Pressure because of shortage and increasing demands of all kinds.\n2. Budgetary reductions \u00E2\u0080\u00A2 Have to study to see what should be curtailed.\n3. Turnover and dissaffection in the staff.\n4. Administrative changes.\n5. Need to compare service load of the present with the service load of the past.\n6. Opportunities to expand because of better housing, better equipment, etc.\nWe need to know for whom we are making the study,\n1. For the administration or\n2. The entire personnel of the agency or\n3. A selected group or\n4. The total public or\n5. All of nursing.\n -141-\nWhat difference does it make which you are studying for,\n1. In the completion\n2. In the finished job presentation\n3. In the style of writing, composition, terminology.\nIdentifying the problem for study, put a fence around it and do not have too\nmuch fencing, that is, have a small problem. Select the part of the area you want to\nstudy. People are inclined to bite off somewhat too big a piece of work to do in the '>\ntime available. It is most important to narrow, to define, to delimit the problem you\nwant to work on. Consider the practical aspect of whether there are data available.\nIf you want an experience in doing a systematic study, begin at home, that is, for .,\nexample, study your own records. Time and cost are important factors. Interest a number!\nof people in helping. The value af to individuals in being in on a piece of research is '.\nenormous and a fine moral builder. Sa i\nSorae aspects of the problem which could be studied, for example, what is the\"\neducational problem in this institution. This becomes a curriculum study. How is the\neducational program operated? This becomes a study of method. Where? this becomes a\nstudy of background, habitat. A sociological study. Why? this becomes a cranaaixa\u00C2\u00B1adyx\ncasual study. Caused study, what are the reasons for. Of what use, becomes the study 1\nof outcomes and products. When selecting a title, make it intriguing, for example one\nstudy which was called \"Do Adolescents Need Parents\". What types of study are most\nlikely to succeed in less experienced hands. A problem of limited scope, of simple\nmethod in the field which is familiar to us. Nursing needs philosophical research now\nalmost more than at any other time. Dr. Brown's is a philosophical research study. A\nhistorical research is one which could be done, for example, the recent story of the j\nFranice Payne Bolton School of Nursing in Cleveland. This is a very fine piece of resear\nch work. Then there is the survey type, Observational and direct observation. .We are\nnot as comfortable about experimental research in the social sciences. H is much harder],\nto control the situation. \u00C2\u00BB\nPlanning the study -\n1. Arrange a series of work sessions to discuss the steps. Once a week or two or three\ntimes a week. Sit down to think the thing out. De-ldmit the problem. Divide the\nareas of work, select thd people. Choose a chairman and secretary for each group.\nBuild a time program.\n2. Collect the data.\n4.\nSummarise the data.\ninterpretation, This is the most difficult part. It requires creative thinking.\nThis is the process in which you say Bwh*t does it mean\" \"what significance is it?E\nWe must replace impressions with facts. There are enough people studying problems\nand if we report them we would have enough for a basis for generalization and that\nwould mean a great deal for nursing.\nThere must be a reason for writing the report. Make this in a planning session.\nThese steps are necessary - a statement of the problem, background, analysis,\ninterpretation, recommendation. There has been a lot of systematic study done in\nnursing, but nit been reported. Therefore, get into the way of findings with other\npeople. The fact that the study is going to be written improves it 50%.\nSummary of the foregoing - 1. We cannot afford to study our problems any wa/rfy but\n -Ineffectively and we have not time not to do these studies. We must not make important\ndecisions on the basis of snap judgements.\n2. Certain aspects affecting the type of study.\n3. De-limit the study to make it practical.\n4. Planning of the stuiy,\n5. Write the study.\n6. Never think of exhausting yourself in the thing you do, think of it as an on-going\nprogram.\n7. Get reinforcement of judgement by having some consultative advice.\nTORONTO HEALTH DEPARTMENT.\nStarted observation and conferencing with the Toronto Health Department,\nMonday, February 14th.\nConference with Miss Keefer, - In the last two years the Toronto Department have taken\non at least 120 nurses, all of idiom have been public health trained. They have had an\nexceedingly high turnover. It is due in part to the fact that there were a number of\nolder nurses who retired and these had to be replaced. However, in ensuing conversations and observations I find that there is a great deal of dissatisfaction among the \u00E2\u0096\u00BA\nstaff. Miss Keefer has a final interview with the* but more than that is necessary in\norder to determine the real cause of job dissatisfaction.\nThere are eight districts with eight district supervisors and supposedly in ,\neach, a senior nurse. The number of nurses in each district varies from 14 to 20. They\nhave thirty child health centres. They have a great many \"not found\" visits. Last year\nthey averaged 27%. The budget quota of the nurses is 169.\nMiss Keefer is alarmed about the separate divisions of T.B. and V.D. The T.B. .\nhave four nurses. Dr. Young is in charge and Miss Larkin the consultant. The V.D.\nhave eleven nurses, Dr. MacKay is in charge and Miss Harrison is consultant. There is\na tendency for these divisions to be built up as separate units. These nurses are not\nincluded in the budget quota mentioned above. But the division of nursing is expected\nto find replacements for thera. There is also a division of mental hygiene under Dr.\nLewis and Dr. Scott. Miss MacEnanay is the nurse in charge. They have a nutritionist,\nMiss Moyie. There are three consultants - schools, Miss Lovell; Maternal and child\nhygiene, Mrs. Troop; educational director,Miss Kayle. In addition there is a supervisor\nof hospital health service, Miss Carroll and an assistant director, Miss Roberts. They ,\nalso have a senior nurse in the office, Mrs. MacLaren.\nIt seems to me the responsibility of the nursing division to distribute free\ninsulin and they have 800 people coming to the nursing office for this. There is one\nclerk on this job full time and two others devote part time to it.\nIn regard to clerical staff, five of the districts have three clerks each and\nthree districts have one clerk each. They are short two clerks of these above at the\npresent time. There is a very great need for more cl/erdcal assistance and also for\nmore supervisors. They hope to have more district offices* Miss Keefer has an idea\n -143-\nto appoint two regional supervisors. I think this would be very bad administrative\nwi2J\ V\" a n^S icts have a District Medical Officer in each, not all are public\nhealth trained. They do chiefly school work they are not really responsible for 7 I\ndistrict administration. They do not take any responsibility for tho tuberculosis, the\nnurses do this. In addition, they have doctors for secondary schools and additional\ndoctors for the Child Health Centres. The District Medical Officer visits cases of\ncommunicable disease. , I\nMeeting of the Nursing Consultant Group in Miss Keefer's Office.\nI believe this group meets one morning every two weeks although it may be\nonce a week. Dr. Pequegnat was present for part of this meeting. The consultants\nsaid that there chief problems were lack of clerical staff, the need for more super- :\" I\nvisors, more suitable quarters for demonstration area. Mrs. Troop brought up the fact\nthat the public health nurses needed in their preparation more emphasis on the pre-nataj J\ngroup teaching method, the actual technique of manual egression of breast milk. '\u00E2\u0096\u00A0 I\nExperience in nursing schools, more on normal child development or on mental hygiene\nand nutrition. There was a feeling that they could have less bacteriology, they need 3 Sj\nmore on counselling methods. There then followed a very interesting discussion on\nmedical social workers. There seems to be a feeling that I may make a recommendation\nthat they do not have public health workers in hospitals. I said that I felt that\nthere was a need for both groups and tried to explain how the medical social worker can\nact as a consultant and mentioned Miss Clarkson. Hiss Carrol said they were getting ,1\nvery nice referrals from her and seemed to be very satiisfied with her type of work. , I\nIt will be however, a long tim e before the feeling against the medical social work 3 I\ngroup can be overcome. They are very protective of the public health nurse in hospitals and go back to the fact that this was the way it was started. It is difficult to\nbring to their attention the fact that we have progressed with the times and that 1\nperhaps now there is time for a revision, that we cannot always go along in the same\nThe district supervisors meet every other Tuesday morning, I was present at\ntheir meeting. The consultant group in the central office do not attend this meetings.\nMrs. McLaren the senior nurse does, although for why I cannot understand because she * I\nnever opens her mouth. The V.D. and T.B., consultants were not present at either\nmeetings. This, I think is rather a handicap, especially if Miss Keefer wants to keep\nthe divisions closer together.\nThe supervisors expressed the needs of the nurse as more public health ^^^\naffiliation in the undergraduate course, the need for more mental hygiene and for\nsocial case work techniques. They have a very definite feeling and so have tie nurses\nin the districts, that the social workers are getting more than the nurses do. The\nsocial workers feel that they should handle many of the problems in relation to mental\nhygiene. There is a feeling that the nurses do not recognize our problems. In nutrition they felt that the nurse has a sufficient amount of knowlege but that it is not so I\nvery practical. Their chief supervisory problems are the lack of accommodation, desk\nspace, etc., and the changing staff, also that they have too many nurses to supervise. ,\nI was pleased in discussing the public health who they are now taking on the E I\nstaff that there is a definite feeling that the nurse from the integrated course at the *|\nuniversity of Toronto School of Nursing, is, after she has had experience, a better\nnurse than.the nurse going through three years and then taking a year post graduate. |\nThis is a different tune than it was nine years ago. They feel that anyone in their \u00E2\u0096\u00A0 I\nfirst year of experience is on about the same level but once some experience has been ' j I\ngained, these nurses show up to better advantage.\nThe supervisors discussed the mental hygiene program and all expressed how ||\ninspiring Dr. Scott is. They are very interested in the program. Dr. Scott and\n^aA\"\n -144-\nMiss Melnenany I believe have paid about six visits to each of the districts in the\npast year and they have taken up case histories. This is very excellent in-service\ntraining and shows what can be done as long as such a program is put into effect. It '\ntaaoiifltratea tlMfe urteres't is definitely developed in that way. Although the nurses\nfind the writing of the case histories for the mental hygiene division difficult and\nthey take a long time, they seem very interested, they will e^en do them at home.\nConference with Mrs. Troo p, Consultant in Maternal and Child Hygiene. I think there\nare about seventeen pre-natal classes held during the year. They are under the\nauspices of the Welfare Council of the Community Chest. There is a talk now that these\nwill be turned over to the Health Dept. as the Welfare Council feel that they have\ndemonstrated the project. The chest controls the budget to which all agencies contribute. The Health Dept. gives $400 per annum and also the time of our nurses to teach\nfour groups. The classes are held from 1.30 to 4.30 once a week for seven weeks,\nevery ten weeks for each of the four nurses. The other three classes are taught by a ''\nnutritionist. This means there are ten classes for each mother. Each nurse keeps on\nin the same district for one year and there is a substitute in case she might be off\nill. Their gre-natal group teaching program seems to be better developed than in any\nother place I have visited. Practically ninety-nine percent of the mothers attending\nare from private doctors. The staff cases go to the hospital out-patients departments\nand do usually attend the pre-natal classes. The nurses do not follow up these mothers\ninto the home. In relation to pre-natal health supervision, there seems to be much\nmore done here also than in other places. Mrs. Troop provided sorae statistics which .\nshowed that in 1948 the Dept. of Health made 7438 visits, to 2145 individuals. These (\nwere many more than the V.O.N, who made 4718 visits to 1,668 individuals. The V.O.N,\nstatistics were for greater Toronto. The St. Elizabeth's were also for greater Toronto\nand made 780 visits to 226 individuals. 700 mothers attended pre-natal classes in\n1948. This means that a total of 12,936 visits were made and 4,739 individuals contact- :\ned throu^i the hofee visits or the pre-natal classes. This is 38% of the total number\nof mothers confined in 1948. There were 12,490. This means that there 7,751 pre- j.'\nnAtals not contacted in any way by the public health nurses. Approximately 3,461 or\n27.5% attended obstetrical clinics. Preseumably these are the ones that are followed\nup, at least these are included in the follow-up in the home, although it will be 3\nnecessary to check on this information. This means that 72.5 % of the total pre-natal J\ncases were private physicians.\nMrs. Troop also has statistics which showed the percentage of mothers who\nreturned for post-natal examination. In 1946-55.1%, in 1947-58.3, in 1948-56.4%.\nThese were mothers from the hospital obstetric clinic, not including the Toronto General\nHospital,\nInfant welfare program - They get the birth registrations and try to visit all new\nbabies. Last year they visited 89% at least once, 51.6% of all came to child health\ncentres, in 1947 this was 46% and in 1946-40%. This shows a gradual increase in the\nuse of the child health centre. The nurses will give demonstration baths on request\nand will demonstrate the preparation of a formula. In the child health centres the\ninfants and pre-schools come togeteher. Diphtheria and pertussis immunization is given '\nby the doctor and there are two doctors in every child health centre. Vaccinations for E\nsmallpox are not done there, mother must take the baby to the City Hall if she wishes\nit done by the City Health Dept. In the child health centres they try to have a ratio\nof one nurse to ten mothers on an average. They never have more than five or six\nnurses in each centre. Volunteers are used. The average attendance in the centres last\nyear was forty. In the thirty child health centres they have weekly afternoon sessions,\nThere is one centre to an average of 23,000 population. The nurses are not allowed to\norder new foods, i.e. orange juice or cod liver oil, eggs or vegetables. This is quite ,\na handicap. They can discuss it with the mother and they will say to her that when she i\ngoes into the doctor she should ask him about it. The mother sees the doctor when she |\nfirst brings the baby to the clinic and then p.r.n. There is no nurse's conference\n -US-\nsession without the doctor. Mrs. Troop again emphasized the need for the younger\nnurses to have experience in manual expression and she feels that they are short on\nknowledge on child development. The nursery school is also desirable, it is regrett- f\nable that they do not have nursery school experience.\n+k + /rt* ^ ff1^1011 to breast feeding, a spot count in child health centres showed\nthat 4Q* of the mothers in the summer of 1947, were breast feeding the babies. This I\nwas oaken on a thousand mothers with babies under nine months. 75% of those answering\na questionnaire prepared for the Welfare Council were breast feeding their babied.\nThere were #)0 to 500 in the check who returned the questionnaire, presumably there\nwere more in the group who did not return the questionnaire who were not breast feed- ,\ning the babies. Mrs. Troop feels that now that mothers are giving so raucjr better care\nphysically to the babies and they are needing so much more help in the social and\nmental adjustment field, this is where the nurse needs to be prepared to give this\nhelp. ,,\nSince 1943 they have used about 40 of the V.O.N, in child health centres.\nThe V.O.N, nurses are paid $1.25 per hour. They are limited to the use of this number l\nbecause they are limited to the payment of 125 hours weekly. There is a great advantage in this plan to both agencies. As it brings the nurses closer together in their\nwork and gives the V.O.N, added interest. They only use the V.O.N, who are public\nhealth trained.\nMrs. Troop said that there were 9,000 mothers in Toronto in 1947 who were\nnot contacted by the nurse, 3 j\nOne afternoon I visited the Manor Raod Child Health Centre. Miss McKelvey\nthe senior nurse forthe Yorkville District was there and showed me the routine of the\ncentre. They use a large room in the basement of the church. The attendance of about\n60 mothers with infants and pre-schools. They have one xxa\u00C2\u00B1 small place with a\nvolunteer in charge where the pre-schools play. This is really just a table with smallfc\nchairs. They have two doctors, one at each end in separate rooms. Dr, Gillies, a\nprivate doctor and an interne. The interne apparently gives the immunizations. There\nis a nurse in each room where there is a doctor. As stated previously they only give i\ndiphtheria and pertussis here and the mothers must take the babies to the city hall *\nfor vaccination. This seems to me to be a great draw-back. They had two volunteers\nweighing the babies. They do not measure. One nurse interviews the new mothers and\nanother nurse interviews the old mothers. With the two nurses and the doctors which\nis an attendance of four nurses plus the one in charge. Two of the four are V.O.N.\nThe Health Dept. nurses arrive at the Centre about 12.45 to set up the child health\ncentre. The volunteers do not help with this. Here again there is no space where\nmothers can be interviewed privately. This is a great lack in all our child health\ncentres.\nTuberculosis Division - Dr. Alan Young is the Director of this Division and Miss\nLarkin is the nursing consultant. There is a staff in addition, of three nurses and\nfour clerks. All the T.B. records come to this office. They are put in the register, j\nput on a list for the San. and then decentralized to the district offices and hospital\nhealth service if in a hospital. Two of the nurses visit the Sans. Miss Clark visits *\nWeston and later on I am to visit with her. Another nurse visits five smaller Sans. j\nEach San. has a visit about three times a year. The nurse gods to Weston weekly.\nThese nurses act in liaison between the hone and the patient and the San. See notes\nlater. In relation to post-sanatorium care they have boarding homes where the landlady .'\ngets $66 a month and the patient $10 per month. A third nurse looks after these. '\nConsultant, Miss Larkin, visits the district offices tko or three times a year.\ndoes not go very often to the consultant or supervisory meetings. They have a high\nschool survey every fall when they patch test Grade 9 and 12. Of l6,000children\npatch tested, they admitted ten to San.\nThe\nShe\n -146-\nDivision of Venereal Diaftftgft rw^-i . i*. McKay ig ^ char but he w&3 out and j\ndid not see him. Miss Harrison is the nursing consultant. They have eight so-called\nepidemiologists who are public health nurses and one male investigator. He is chiefly y\nresponsible for court cases. There are four clerks. One or two epidemiologists are J\nattached to each of the six hospital clinics. The/ diagnosed cases are referred to\nthem for interview (See notes later and visit to St. Michael's) The epidemiologists\nfollow the contacts. The nurse in the distric t follows the delinquents with very ,\nfew exceptions. Miss Garrow is a specialized worker who acts as a liaison at St.\nMichael's. Interview with her later.\nVisit to St. Michael's Hospital V.D. Clinic - St. Michael's has over 700 beds. In the\nV.D. clinic there are two full time hospital health service nurses. Miss Murphy and '\nMiss Clavir. In addition at the female clinic which I attended, there is an epidemiologist called \"Eppy\". Miss Cavanagh was the one present when I visited. Then there t\nis Miss Garrow xka to whom is referred special problems. The routine seems to be this, ,'\nthe new patients are given a number when they come in and they are then referred to the\nhospital health service nurse. Miss Murphy sees the men and Miss Clavir the women.\nClinics are held on separate days. I cannot see that the nurse who is not interviewing \u00E2\u0096\u00A0\nthat Miss Murphy on the women's clinci day can be kept very busy. The hospital health\nservice nurse explains about the treatment. How long they will have to corae and what\nhappens if they don't. However she probably does not do this before the patient is\nseen by the doctor. Her first interview with the patient she takes the history. The\npatient then sees the staff doctor. If it is a case of a blood test he takes it then\nand the patient has to come bacjk in a week. If it is a case of g.c. a smear is taken\nand diagnosis is given that day. They then go back to the hospital health service nurs '\nfor an interview , at which tine she explains about the treatment add how long they\nwill have to come and when they must return. The patient is then sent on to the\nepidemiologist who interviews for contacts. These epidemiologists who are on the\ndivision of V.D, Control do the follow up work in the district. If there is a special\nproblem they are referred on to Miss Garrow. I can see the need for this referral to .\nMiss Garrow, it is very important. But why the hospital health service nurse could not'\nfind the contacts and refer to the V.D. division I am sure I cannot understand. This\nis an extra person that the patient has to see and he realizes that this is just one\nmore person who knows his story. Apparently the patients report to the hospital health,\nservice nurse about every time they corae in. If they do not keep their appointment the. ;\nnurse informs the hospital health service who notifies the Division of V.D. control at\nthe City Hall. However, if they are delinquent just once, the first time a letter is\nsent to the district nurse. If she does-not get them in then the epidemiologist will\nfollow up. On the last day of the treatment the doctor takes a blood test and they\nmust then return once a week. They are not seen again by the Hospital Health Service\nnurse. They are now using procain penicillin, ten injections, three each week.\nassistant\nIn relation to the treatment at the moment the/supervisorof the out patient ;\ndepartment gives the treatment for syphilids. Some of the treatments are given by\ninternes. There are also student nurses who are preparing the treatments. The j|\nhospital health services nurses also do the ward work. If a patient is found positive\nthe nurse visits and interviews. The dpidemiologist also visits for contacts. Here\nagain is duplication and where does the hospital nurse herself, both graduate and\nstudent, come into the picture. Are we not again taking all the teaching away from ifcm\nthem. 'j\nMiss Garrow is an exceptional person. She has had experience in hospital\nhealth service work, then she took a three weeks course at the Psychiatric clinic. To ,i\nher special cases are referred, also chronic defaulters and she trying to do a study\non these to see if they can iwiwsaxtk reduce the number of times they default. Her 1\nwork is really an experiment and she has only been doing it for seventeen months.\nShe follows her own case to the ward if the patient happens to be admitted. I sat\nwith her while she interviewed a couple of patients. As was suggested in our nursing if\nconsultant meeting, perhaps there is some special quality in the individual which fits ij\n -147-\nthem for this particular type of work. I can see that Miss Garrow might be able to\ndo these social aspects very well without the preparation, but that i s not so with\ntiie average public health nurse. I was certainly not impressed with either Miss Murphy\nor Miss Clavir. I then saw Miss Kavanagh, who is the epidemiologist. She interviews\nthe new cases for contacts. The day I visited she had one patient for interview and\nthis happened to be a man who came in. This waw unuaual because this was a women's\nclinic. She will follow up the cases in the district and the defaulters that the i\nnurse was not able to get in. Her last months case load was about 58. She ssys this\nis the average for the nurses. It does not seem to me to be a very heavy one. Miss\nKavanagh over a year ago completed her degree work in supervision in public health\nnursing at Columbia University, and yet here she is on this specialized program. She ,\nrealizes herself she should be in the general field but she says that there is no\nchance for advancement in this department for a very long time, and they are in need ;\nof senior nurses in their districts. I cannot understand it. Miss Kavanagh is in r\ncontact with Miss Moore and is xx probably going to a County Health Unit this year.\nInterview with Miss Cale. Educational Director - Miss Cale is responsible for staff\norientation, in-service training and the students' program. The orientation consists\nof the four days of int^gguctory conferences. Afterthis the new nurses go out to the\ndistricts and they are/responsiblaity 0f the supervisors. The in-service, they try to\nfind out the staff needs. Two hours per week is ddvoted to staff education. One of\nthese hours is on administration. The staff education hour is for visitors and\nconsultants. There is very little staff participation, they have no bulletin. Each j\ndistrict has a library and there is a nursing library in the eity hall, with catalogue\nof magazine articles. Miss Cale has not yet divided up the responsibility of indexing\narticles nor has she really tackled the in-service training program. It is largely\none of arranging for appointments for the consultants in the districts. She has\nvisited with some of the consultants and admits herself that there is not nearly enough\nstaff participation. I imagine that the amount also varies with the district supervisor\nAll the supervisors took a special administration and supervision course at Toronto\nUniversity. This consisted of lectures one full Friday each .week for the year. None\nof the supervisors have a special certificate. Two of the senior nurses do have\ncertificates in Administration and Supervision. The studdnt program, the take the\ncertificate for one month, the advanced course for one month and the degree course\npeople come for one month and then each fall for one day a week. They do not have a\nconference roora and do not have conferences with a group of students while they are\nwith them for field work. Miss Cale gives then a lecture at the university. At the\npresent time they are not taking students from hospital. Miss Cale told me about the\nhospital health instructors meeting whieh is held monthly and I have been in contact\nwith Miss Smith to attend it. I will get raore details of the student program there.\nThe health department also gives observation to medical students in their senior year. '\nThis consists of a lecture plus a half days visiting with the nurse in the field.\nWhen they introduced this program they dropped the student nursing program. The work\nwith the student nurses is largely through lectures.\nConference with Miss Lovell. School Nursing Consultant - In the schools the doctors do\na physical on grade 1, 7 and 9 and the leaving grade and also special referrals. The\nnurses preparation for the doctors examination consists of weighing and measuring the\nchildren, doing the vision test and writing the parents for grade 1 and grade 7. There\nis a good response to the gracb 1 invitations but not to the grade 7. They feel that j\nthe children in grade f discourage their mothers from coming, and yet they insist on\nsending out the invitations. The nurse duty for the other grades, that is 2,3,4,5,6,\nend 8, inspects the children each child in the health service once during the school\nyear. She does the vision test on grade 4 but not on the other grades and any other\nwith vision defects which aar^adxsjBX have been narked up. She weighs the children\nonly where indicated. The teachers, as a rule, do not take any responsibility for\nweighing or vision testing. Instruction is given to the teachers on a form which is\nincorporated into the register. The majority of the nurses meet with the teachers and\ntalk with them, but not by any means all the nurses do this\n -148-\nAll defects are referred to the doctor before a note is sent home. After the inspection of a class roon, the nurse holds a conference with the teacher. The nurses are\nnot responsible for sanitary inspection. The M.O.H. is and fills out a form yearly.\nIn the high school program there is a great deal of health counselling. There is a\nGuidance Department set up under the provincial department of education in each\nSecondary school, the staff consists of a Chief Guidance officer, a man and also a\nwoman. The set up and program varies in each school. Dr. lewis goes in on request. I\nIn some schools the Guidance group works very closely with the nurse. (See notes\nlater on visit to District Office and the school.)\nConference with Miss McRnnan^y. Consultant in Mental Hygiene. I did not get a great ,\ndeal out of this conference except to learn that Miss McEnnaney arranges for the\ninterviews with the doctors and that she and Dr. Scott had made six visits to each :\ndistrict in the last year. This is very commendable. There are some extra nurses '\u00E2\u0080\u00A2\none at each school for mental defectives. I do not know how many of these there are. ''\nApparently they did try out social workers but found that they were not successful\nin this situation. They have two school guidance centres and they have a close working'\nrelationship with the social agencies and the hospitals.\nVisit to District Office. The morning of February 21st, visited Runnyraeds District\noffice. This office is on the second or third floor of the Runnymede School. The\noffice space consists of one vacant class room and in addition they have a smaller\nclass room which they use as a lunch roora. The nursing supervisor, the doctor and\nthe nurses and the clerks are all in the one large room. Miss Harshaw, is the j\nnursing supervisor, Dr. Moffat, the medical officer of health, I did not meet him.\nThe population of the district is about 89,000. The remainder of the staff consists\nof a senior nurse, Miss Mclntyre and fourteen staff nurses, they have one clerk. In\nthe district there are eleven elementary schools, five separate schools, two secondary 5\nschools, and in addition they have a school in the housing unit at Malton, although\noutside the area of Toronto, this is included in Toronto as the residents are residents of Toronto. There are three child health centres. There is also the school in\nHigh Park, the open air school which goes fro* May to October, it has about 210\nchildren. The supervisor is responsible for the administration of the office and\nsupervision. The senior nurse does most of the outside supervision. During the first \u00E2\u0080\u00A2\nyear they tried to visit with the nurse three to four times and second year, two times\nand the third year at least once, and each succeeding year once. They have evaluation\nreports which are sent in regularly.\nA family record is made out if they are going to visit a home more than once.\nThe nurses receive birth registration notices. These are usually received when the hse\nbaby is five days to a week old and they try to visit the home not later than two\nweeks. The V.O.N, notify the ttealth Department of the cases they are visiting and they\nsend follow-up reports, this avoids duplication. Pre-natals, they are not referred\nto the V.O.N, unless they are to be confined at home. They have a very small T.B.\nproblem. They have individual records for T.B. or if only one individual in the family\notherwise the family record covers all.\nA staff conference is held once a week at 11 a.m. on Fridays. The first i\npart is administration and the second part if they have sorae educational report. They\nhave a planned program for the consultants visit and if a consultant is coming, they\ncome from one to two. There is no report from the staff education program. The !\nnurses take part in the mental hygiene program. They get the report from the clinic\nand they do the follow up in the home. The attendance teacher in the schools cheeks\non absence. The nursed do not have to check on those absent except those reported ill. (\nIn this area there are four dental clinics going half time. A dental survey is done\nonce a year by the survey dentist. The nurses are responsible to make appointments\nduring the year. |||\n -149-\nJ^/!2arblBent suPP!ias the following magazines - Public Health Nursing,\nParents, Child Study, Hygiea, Canadian Journal of Public Health.\n/a*1\u00C2\u00AE*11^ a Visit with Miss Harshaw, I went down to the Health Service room\nof the school where Miss Mclntyre is the senior nurse and was relieving for the regular\nnurse. Miss Mclntyre says that it takes from nine to ten each morning to do re-admissions. She says the teachers screen thera quite well. The doctor^ examines grade 1 and )B\nthe kindergarten and then grade 7 and transfers in. Grade 4 has a vision test. Miss\nMclntyre says there is no regular meeting with the teacher to discuss the class. Every' .\nclass is visited by the nurse. She send for the child with defects first, then those\nwho do not have defects are sent for and inspected in the medical roora. I think that\nMiss Mclntyre means that all the children are inspected in the medical roora and not in . ' i\nthe class room. Then follows a conference with the teacher. The reference above to \ .\nno conference with the teacher was in relation to education about screening the childrei\nthat should be sent to the nurse with signs and symptoms of communicable diseases, etc. ,i\nThe nurse weighs those that under weight. Miss Mclntyre complained that Miss Jones was\nbehind with her work, she made a remark that she spends too much time on her finger , ]\nnails or rather on nail-biting. In relationto immunization, the toxoid team comes to i\nthe school, they review all the A.D.P. cards and send out the notices to the parents.\nVacconations are done by the school doctor in the school. In relation to communicable\ndisease, if a case is found in the class the mother is phoned to see if she could get ,\nher own doctor. If not, the M.O.H. must visit to make a diagnosis. Then the quarantine officer visits ri^it after it is reported and he goes back to give release. The\nnurse may visit first if the child is at home, then the doctor then the quarantine\nofficer. This happens with chicken-pox, german measles, mUmps, measles, scarlet fever, !\ndiphtheria, polio, etc. The latter three are placarded by the quarantine officer.\nI did not see any of the matrons but I believe that these matrons are employee\nto help eradicate sniobekraxix pediculosis, now she also apparently helps with clerical\nwork with the nurse, (see notes later re conference with Miss Love 11 on matrons.)\nMiss Mclntyre*s duties in relation to the senior nurse position are supervision of the nurses, visiting the boarding homes, student program. Miss Mclntyre is one\nof the older type and I would not think that very many of the modern principles of\nsupervision are followed. I should imagine that there would be little incorporation of\nmental hygiene either into the instruction or into the supervisory techniques.\nVisit to Weston Sanatorium with Miss Clark from the T.B. Division. On the morning of\nMarch 9th, met Miss Clark and went with her to the Weston San. This is a T.B. San.\nof about 650 beds. Dr. Wicks whom I met, is the superintendent, Miss Bell is the\ndirector of Nursing. Miss Clark as the public health nurse from the health deparemtne\nvisits each Wednesday for a full day. She contacts the patients who are residents of\nToronto. There is a Miss Beckwi/th who is a graduate of the University of Toronto\nSchool of Nursing who admits the patients. She claims to be a public health nurse but\nhas not had any experience in public health. She feels that this is a draw back she\nshould have got some experience in public health first. Her reason for going into the\ntuberculosis work was that she felt that was a weakness in her public health preparatioi'\nand would have to get nore experience in it. As far as I can make out she sees the\npatients when they come in and gives them some information in relation to tuberculosis.\nI suspect that she does not give as much as KxxmKtannac Miss Fenton seemed to try to d\u00C2\u00AB\nbut I am wondering if it is not too much even at that. She mentioned the posters on\nthe \u00E2\u0080\u0094**\u00C2\u00BB walls for their benefit. These wer not very attractive posters in the room\nwas certainly not an attractive room for the first contact of the patient with the\nhospital. Miss Beckwith in addition follows up the new patients on the admitting ward. I\nThere are two admitting wards, one for men and one for women and the patients are kept J\nhere anywhere from a few days to two weeks. They are kept at least until diagnosis is 1\nconfirmed and it is established how much activity they can have. They may be kept\nlonger depending on the availability of a bed in the regular wards of the hospital.\n -150-\nApparently Miss Beckwith tries to do some follow-up teaching. After they go to the\nregular^wards there is apparently very little done. There seems to be absolutely no\nin-service training program Smxxg with the graduate nurses. I learned later that most\nof the charge nurses are graduates of the Weston San. Up until ten years ago it was\napparently operated as a school of nursing with affiliation with General Hospital.\nMiss Bell the superintendent seems to me to be a bit of the old school type. They do\ntake students for affliction and Miss Elridge is in charge of that program. In additioi\nto Miss Clark coming in from Toronto there is a nurse visiting regularly from York Twsp.\nanother from East York. I went wdth Miss Bell to visit some of her patients - One was \u00E2\u0080\u00A2\nin relation to a transfer from another sanatorium. This man had been in another San.\nand was sent down to the Toronto General for thoracoplasty. However, this was not done ,\nthere and he was brought out to Weston. He complained very bitterly about the treatmeat\nin the Toronto General. There did not seem to be any problem here as far as the district\nwas concerned or anything that Miss Clark needed to handle. The second case was a man\nwhose problem seemdd to be that his wife had been given notice to leave their apartment. '\nHe was wondering if there was any way to get around it. This again, is not a health\nproblem but a welfare one. The third, a man whose wife and child lived in one room, she '\nwas on Mother's Allowance, he has been told that he can leave the San. very soon and is .\nconcerned about getting another living quarters. The nurse said that he should get in\ntouch with the catholic welfare. Here again is a welfare problem. The fourth ease was\na young lad who had been admitted,about 20 years of age, he cannot read or write. There\nwas no problem as far as the district was concerned. We then went to see a woman who\nwas pregnant. Miss Clark had seen her previously and had discovered that she had been\ngiven to understand that the baby would be kept in the hospital as long as she would\nbe there. When she found that this wasnot so she was very upset about it. Miss Beckwith is supposed to follow up these pre-natal cases. Miss Clark wanted to go back to\nreassure the woman and see if she had adjusted to the situation. She found that Miss\nBeckwith had not been to see her and was rather put out about it. Miss Clark left the\nred book which is the bible of the Toronto Health Dept, and some patterns for knitting,\nthe woman was already knitting and seemed to have plenty of patterns. The next visit\nwas to a young girl who was pregnant. She took her also a copy of the bible. The girl\nhas decided to get married and had her engagement ring. Here again it seems to me that\nthis was really a welfare problem, it is quite true that this young girl needs a lot of\nencouragement and somebody to come to talk to her. In relation to the giving of information, such as the red book, the public health nurse, Miss Beckwith already on the staff\ncould have given this. Or failing this why could these not be given to the charge\nnurses. It seems to me that every bit of responsibility for this type of thing is taken\naway from the hospital rather than given to them and encouraging them to know the\ncommunity resources and xxfsx let them make use of them. There is no doubt about it\nthat someone doing something the same type of work as Miss Clark is doing but more of\nthe welfare and case work is needed and is needed full time on the hospital. Three\npeople, three public health nurses in addition to the public health nurse doing the\nadmitting and a dabbling of the teaching seems to me to be a very confusing picture\nadministratively. Before going on the rounds with Miss Clark I had met Dr. Wicks and\nI brought up this question of duplication, or possible duplication. There difficulty\napparently is funds, how would they get money to pay for this extra worker supposing\nit would be a good policy to have her on the staff. I pointed out that the tax payer\nIs paying for it whichever way it is and a duplication is a more costly business than\na policy which would avoid this duplication. We had a long discussion with one of the\noccupational therapists who seemed to be a very understanding person. She too meets all\nthe new patients and this even before they have been given the diagnosis and clasiified ,\nfor occupational therapy. Her point was that they need to meet people and that every\nextra contact helps. This is true but this is not her function. There should be a\nmedical social worker in my opinion attached to the staff of the hospital who will pick\nup these things and who will make the necessary referrals to the district. I think the\nmajority of referrals are welfare. It migit be avery good idea for a study to be made\non this aspect, even if the nurses who visit the San. could classify their ref|rrals\nover a period of two months, they would then see what the chief classifications are.\nm\n -151-\nThe occupational therapist, vocational guidance man and the principal of the school,\nMiss Slater, meet in a conference every two weeks to discuss new patients. It is\nproposed that soon this conference will be enlarged and will include the doctor and\nthe nurse of the wards concerned with the cases they are going to take up. After\nlunch I had conference with Mrs. Dalvel who was a public health nurse for many years\nwith the health department, the latter part of the time being with the mental hygiene\ndivision. She felt that she needed a change and went to Weston to take the postgraduate course. When she was finished with it she was asked to join the administrative\nstaff, I really do not know what her particular position is but she seems to be\nresponsible for some of the education of the nurse aides. They have about 35 nurse\naides I think, and about 8 practical nurses, I am not sure how many graduate nurses as\nMiss Bell did not have the information at lunch time.. Mrs. Dalvel who told me that J\nthere is no in-service program for the nurses and she thou^it that they were rather too\nrushed to give much teaching. I do not think that she approves of the situation very\ngreatly. \\nVisit to pre-natal class - In the afternoon went to Glebe United Church where one of\nthe largest of the city's pre-natal classes are held. Miss Bale is the nurse in charge.\nThere were about 28 mothers present, I should think that the majority of them primavar-\nous. It is a very good district. Miss Bale has a volunteer who helps with the regis- \u00E2\u0080\u00A2\ntration and prepares the refreshments which consisted that afternoon of apple juice and\na wafer. Sometimes soup is served sometimes chocolate, etc. The whole series of\nlectures are numbered ten. The majority of these Miss Bale takes herself with some of\nthem being taken by a visiting housekeeper \u00C2\u00AB\u00C2\u00BB\u00C2\u00BBiifcg\u00C2\u00BBiti\u00C2\u00AB<\u00C2\u00ABt. and there are two taken by\na nutritionist alone. I would say that Miss Bale is a very individualistic person.\nShe has a very breezy manner with them. She follows the lecture type pretty largely\nalthough she does invite questions. Sorae of her dicturas which are announced might be\nquestioned scientifically and one or two of the mothers did question. Soke of these\nmothers have read a lot themselves and I am quite sure that they were not altogether\nconvinced that Miss Bale was correct. There were displays of book covers and books for\nchildren. Apparently the librarian comes one day and brings the books and many of the\nmothers have had a great deal of assistance because they used the libray afterwards.\nThese looked like very up-to-date numbers. There was Modelling for Mothercraft, How\nto Improve your Bridge, Books on Home Building, Home Decoration, etc. I should imagine\nthat the mental hygiene aspects are fairly well looked after and that this probably a\nvery good class. Since it is one of the largest classes in the city it seems that\nMiss Bale is probably very successful. As I was leaving she gave me some notes that\nmothers had sent to her. During her talks she stressed breast feeding, as a matter of\nfact she started out by saying there were two announcements which always would be made\nat this class and one of them was about breast feeding. When she was talking about\nwhat they should get ready for the hospital and about bud getting for the baby, she said\nat the end \"and of course you won't be including anything about baby bottles, nipples\netc., because you are going to nurse your baby. In reference to the notes received,\nthey all started off announcing the arrisil of the infant and all showed very great\nappreciation of Miss Bale and the instruction. Here is what some of them say -\n\u00E2\u0096\u00A0Miss Bale, I cannot begin to tell you how much I enjoyed the pre-natal classes under\nyour instruction. I looked forward each Wednesday as much for the very definite lift\nyou gave with your sparkling manner as for the fine instructional material. You do us\nall so much good and I know the other girls as well as I became quite attached to you\nas a friend\". \"I am looking forward to getting home to put into practice the valuable \u00E2\u0096\u00BA\ninformation I ganed at the pre-natal classes. They eertainly were wonderfully helpful\".\n\"I want to tell pou how very much I enjoyed your lectures at the pre-natal classes at\nGlebe United Chureh, each day some new thing turns up and I am grateful for the instrue-ij\ntion I got at the classes. It would have been a very weary business, looking after a\nnew baby without having been told what to do and what to expect with a tiny baby. I\nused to look forward to Wednesday afternoon I spent attending your classes. I came\nhome feeling refreshed and terribly thrilled with what happiness lay ahead with the\nbaby and I don't think anyone else could have made these meetings more intersting than 'I\nyou did\". And another one written by a mother when she was still in hospital\n -152-\nand referring to two other friends who attended the classes - \"All three of us have\nenjoyed the classes immensely, Miss Bale and feel much more confident of this business\nof being a mama than we would have otherwise. I am afraid I have practically worn my\nroom mates ears off raving about you and the funit was every week. Thank you for\nmaking it so.\"\nMarch 10T 1%9 - Had a final interview with Miss Lovell and Miss Keefer. Obtained\ninformation from Miss Lovell in relation to the matrons. These are employed so far on\nthe temporary staff but because of civil service regulations they will be on the permanent staff wary shortly, if not already. They ar not picked for any particular qualification, all are interviewed by Miss Roberts. They must be able to handle children well,\nto make a good approach in the home, etc. They are used to help with the pediculosis !\nproblem and they follow up these cases into the homes. The nurses report that the\nproblem is much better,as the matrons have raore time they are helping the nurses with .\nthe clerical work in the schools,in the child health centres, and one of the matrons V\ncomes in once a week to the central office to help the supply clerk. This is the\nnearest thing to auxiliary help of this natnne employed in official agencies in Canada. \u00E2\u0080\u00A2\nIf the Toronto Heqlth Dept. can employ eight then perhaps smaller departments might '\nvery well look into the matter of employing a lesser number in proportion. I would\ncertainly think that Hamilton which has quite a pediculosis problem might well use such '\npeople.\nIn the final interview with Miss Keefer she mentioned the civic visiting. I\nhad not realized that this was a duty of the public health nurses. If any of the civic '\u00E2\u0096\u00A0\nemployees are ill the nurse must visit to ascertain why they are absent. This is\nreally policing and is a very unpleasant task for the nurses. Miss Keefer complains\nthat as new projects are added it is the home visiting that goes by the board. She\nfeels very definitely there should be more group teaching and I think has an idea that\nit would save time. I pointed out that I did not feel, that in actual fact, it does\nsave time. l^fwiiikiiditwBL\u00C2\u00ABkkarfcy?Tni-rBhtH\u00C2\u00BBLKg\u00C2\u00BB\u00C2\u00ABJ^gir and that group tteaching is good but\nthat the more recent writing does not seem to stress it quite as much as previously.\nI was able to discuss in rather general terms the work of the hospital\nhealth service nurse. When she brought up the fact that Dr. Brown wants five full time\nnurses in the hospital for sick children, I pointed out that I thought we needed a\nvery definite and detailed analysis because it seems to me that so often the things\nthat the hospital people did not want to do were put on to the hospital health service\nnurse and that I felt the hospital had a responsibility to erapljry an adequate staff.\nThe hospital health service people should only be there for information for the\ndistricts, I also mentioned the same thing in regard to the visiting to the San.\nMiss Keefer also mentioned that records are not taught at the University of ,\nToronto. Their attitude is that that is the agencies responsibility. It would well\nto look into the matter and see how much of the principles of recording are taught\nbecause these very definitely should be. There are quite a number of complaints from\nthe Toronto Health Dept. nurses about the difficulty of completing records. They have\nbeen used to check system records and they do not like the narrative family record\nwhich they are using now. Of course, the real answer to this is more clerical staff\nand dictation by the nurses.\n -153-\nSt. Elizabeth's Visiting Nurse Association\nJ^1*0 + 2i 4 had ** ^terview with Miss Hefferman, Supt. of the above Association.\nThe staff consists of Miss Hefferman, two supervisors, eleven full time staff nurses,\nthree part time staff nurses, doing night duty only, two clerks and one bookkeeper.\nOne of these clerks is in their Lakeside office. The office at 67 Bond Street serves\nboth as a central office and a district office. Their area consists of the city of\nToronto, Mimico, New Toronto, Long 3ranch, part of Toronto Township and almost all of\nEtobicoke. They also have Scarboro and I think York Township. Twelve of the seventeen\nnurses have public health preparation.\nIn addition to the bedside nursing program, in Scarboro they give health\nservices to three separate schools. There they are paid by the local officer of health.\nIn York township they give a similar service under similar circumstances to two separate\nschools. In 1948 they made 21,365 nursing visits. The bedside program consists of\nmedical cases, to these they give liver extracts, insulin, etc. They try to teach someone else to give the patient the insulin or to teach the patient themselves, but they\ndo not attempt any teaching for the giving of liver extract. They have not given\npenicillin, except for those to whom they are giving bedside nursing care. Of their\nchronic load the largest are the hemaplegias, they do not have many arthritics.\nThey do not carry any Metropolitan Life policy holders,\nvisit is $1.50 an a sliding scale.\nHie charge per\nFormerly they had a very heavy home confinement load between 600 and 700\na year. In 1947 they had 212 home confinements. In 1948, 129 home confinements. This\nservice to mothers on return from hospital is increasing and they are trying to build\nthis up. If the mother comes home on the eighth day they will probably only give two\nvisits. If however, she is discharged on the third or fourth day they will visit to\ngive nursing care to the mother and to the baby. They discharge the cases at the end\nof six weeks. They have an exchange of information system with the city health dept.\nLast year they gave pre-natal supervision to 226 individuals.\nOne of the St. Elizabeth's nurses teach in the Welfare Pre-natal classes.\nThey also have a pre-natal class at St, Mary's Infants Home. These are the unmarried\nmothers.\nMiss Hefferman says they are three nurses short on the budget, in other\nwords, their quota is 20. The minimum salary for the staff nurse $2087.\nThey have three down town child health centres in the three down town jBndni'\nparishes. These are weekly sessions with one nurse and a doctor at each. They have lay\nassistants. They also have a tonsil clinic twice a year. Those who cannot afford to\ngo to hospital may have their tonsils out for $10, or if they cannot afford to pay\nanything, nothing.\nMiss Hefferman suggested that I get in touch with the Welfare Council for\ntheir recommended policies regarding the grading, duties and salaries of the various\nclassifications of nurses, practical nurse, registered nurse and public health nurse.\nI left five or six job analysis forms for the St. Elizabeth's nurses and I 1\nam to return on March 31 to meet all the staff at which time they will have these forms\ncompleted.\n\u00E2\u0096\u00A0nuA,\n/Wa*>- \ 1\n^tJr o-aA\n\u00E2\u0096\u00A0isSm+^jAy\n -HP\nVICTORIAN ORDRR QF NURSES - TORONTO BRANCH\nStarting Monday March 14, spent sometime with the V.O.N. On Monday I had a conference with Miss Cryderman. On Monday afternoon I had made arrangements mi to have\nMiss Petschnigg of the League of Red Cross Societies, Geneva in this office to discuss\npublic health nursing in Canada. On Tuesday spent all day at the V.O.N, with Miss\nCryderman, Miss leash and Miss Palk. On Thrusday went to a district office and on\nFriday to another district offiee and then out with one of the nursing assistants.\nOn Monday returned to the V.O.N, office for a staff education conference.\nIn my conference with Miss Cryderman she told me something of the national\nset up. There are 105 branches employing 479 nurses and they give nursing service to\noneethird of the population of Canada. There is a board of directors in all the\nlocal branches. The local branches have a great deal of autonomy - Toronto have\nalmost complete autonomy. The National office provide a manual, the large branches\nmake variation. The national recommend salaries, uniform allowance, policies regarding staff education, eta. In order to secure public health nursing staff they give\nscholarships. It has just been announced that they are offering $750 instead of $500\nfor the next year. The national is behind the progressive move in regard to staff\neducation, efficiency reports, etc.\nThe Toronto Branch has 97 nurses. It consists of a director, two assistant\ndirectors, an educational director, six supervisors, five senior nurses, the remainder : J\nare staff. They employ both prepared public health nurses and so-called junior nurses,\u00E2\u0096\u00A0\nThey have also five assistant nurses. They loose many of their nurses to take senior\nposts in official agencies. Miss Cryderman feels very definitely that the official\norganizations must keep the V.O.N, strong. They took forty new nurses on the staff\nlast year. Toronto is the only branch that gives scholarships of its own.\nThey have six district offices, varying in size from 7 to 20 nurses.\nThe objectives of the Assoc ition are -\n1. To give part time skilled nursing services and health teaching.\n2. To sit in with the community health program, by taking a greater part in the\ncommunity health program, i.e participating in the child health centres, in the\npre-natal classes and in industry, it adds interest to the work of the nurses and\nhelps to hold them.\nThe nurses have night duty but have this only for about once every 14\nmonths and then for a two week period. Their Sunday dity occurs only about once in\n8 weeks, sometimes it is only for half a day. They get compensatory time for this.\nThere is an initial uniform allowance of $75.00. Apparently Miss Cryderman\nfeels that nurses who are not in uniform do not like it and this fact holds them back\nfrom coming to the V.O.N., but once they get into uniform they do like it.\nThe Toronto Brandh have a statistical department, a central switchboard, a\nbusiness manager, twelve to thirteen secretary. There is one secretary in each\ndistrict office except one, which has a half time secretary. One of the offices gives'\na day a week to each'of the other four district offices of secretarial time. Each\ndistrict is divided into sub-divisions for each nurse, so that each nurse has her own\ndistrict.\nIn 1948 they 12, 991 patients; 148,628 visists. There has been a great\nIncrease in the xaxxai service in the last two years. The increase has largely been\nin the medical and surgical but mostly in the medical and a great deal of this is due ^\nto the increased use of hypodermic therapy visits. The reasons for the increase are\nmAm\n -155-\nthe inadequate number of hospital beds, patients having to be discharged earlier in\n?u w n\u00C2\u00B0 rel\u00C2\u00B1eYe ^ds and discharges from hospital earlier of mothers and babies and\nthe V.O.N, called in for demonstration care. The maternity case load is down very\nmuch over past years.\nBecause of the service which they give to the Metropolitan Life Insurance\nthey have to do a cost accounting. They can say exactly how much a nurse costs, how\nmuch for supervision and how much students costs, etc.\nThe program consists of -\n1. Maternal welfare. The average confinement time is 4 hours.\n2. Postpartum care. This is given to the end of the eight day, and the V.O.N,\ncontinue to supervise to the end of the sixth week. There is very good referral\nback and forth to the Health Dept. and a minimum of overlapping.\n3. Bedside care to communicable disease cases except diphtheria and scarlet fever.\n4. An hourly appointment service. They charge 25 cents more for this, it could be\na much bigger case load than it is and they try to discourage it.\n5. Child Health Centres - 4 to 6 nurses per week, all of whom are public health\ntrained serve in the centres. The Health Dept. pay $1.25 per hour for two and one-\nhalf hours.\n(The nursing visit charge is $1.50.)\nThis service in the child health centre gives another type which makes it attractive to the nurse. In East York previously, all the pre-natals have been handled\nby the V.O.N, but starting the first of last month arrangements were made the\nsame as with the Toronto Health Dept., that is, the V.O.N, accept the cases on\nrequest, take the Metropolitan cases and those cases having home deliveries. All\nthe others from the hospital clinic are followed up by the health department and\nnot by the V.O.N, unless some from the hospital clinic fit into the above three\ncategories. The V.O.N, in East York also help In the Child ^ealth Centres.\nMiss Cryderman feels that it is not fair to the official agency to have an\nincomplet program and neither is it fair to the V.O.H. (Compare this with Winnipeg.)\nThe finances come from the Welfare Council, City Health Dept., etc., it is\nnecessary to make a budget each year to the Chest. Miss Cryderman pointed out that\nfree nursing work is increasing very greatly. This is indicative of the trend and\nshe feels that before long that nursing care will be free, provided for by the govt.\nShe made a statement which is so very true - in agencies we are adding on\nall the time but not taking away a thing. .\nIn relation to student service, the university pays five dollars per\nstudent and fch\u00C2\u00AB\u00C2\u00BB\u00C2\u00AB\u00C2\u00BBm they receive from the hospitals for the undergraduate students\n$1.00 for each student.\n21% of the fees are from patients.\nThe nurses work from 83.0 to 5. the weekly average is 39.75 hours per week.\nThey have an hour and a quarter for lunch and have a day and a half off. In each\nmonth they have two long days. They have good sick time policies. Salaries - see\nthe outline from Community Chest. They have a policy for complete physical examination\nand x-ray before employment. Every two years up to forty years of age they must have I\na physical and an x-ray every year. After forty years of age they have aphysical every\ntwo years and an x-ray as indicated. After the initial physical the nurse pays one-\nhalf the cost herself. 'L\nConference with Miss Leask, Nursing Assistants. They have five nursing\n -156-\nassistants, one in each of the larger offices. They do not have one in the East York\noffice. These assistants work the same hours and have the same personnel policies as\nthe regular staff. The only difference is, less salary. They are very well liked and\nare accepted by the nurses. Miss Palk told me later about the orientation program\nwhich is very complete for them. The supervisors and nurses feel that about one is\nkfcx about all the case load they can arrange for. In North Toronto there are about t\ntwelve nurses and one assistant nurse. The assistant nurse does about six visits a\nday. It is therefore necessary to have between fifty and sixty cases in order to fill\nher case load and its takes a considerable bit of planning on the part of the supervisor to arrange for this and arrange for the least amount of waste in travel time.\nThey feel that if a qualified nurse were doing straight medical care about six visits\nper day is about all that she can make so they really do not feel that the assistant\nnurse in having to cover a larger territory loses time. The assistant nurse does not\nopen the case, the is is done by the graduate nurse. They are not asked to do anything .\nthey have not been taught. They give care only to the chronics, where the original\nteaching has been done by the nurse. The supervisor contacts the doctor and explains\nthat an assistnat nurse is going in. It is also explained to the family, the same\ncharge is made. The assistant nurse may give general nursing care, a simple enema,\nan sterile dressing, she does not do hypos. A graduate nurse does every fifth visit.\nThis is not direct supervision. The unifrom of the assistant nurse is the same style\nas the regular nurse but it is green with a gray coat. The asistant nurse does not\ncarry a district but she does carry a case load. This is done because they feel that\nshe is happier having to plan her own daily work end not having it handed to her each (\nday. They report back to the graduate nurse if there is anything they feel they\nshould. They do not feel that these nurse assistants take on too much responsibility\nand are very well satisfied with their service. The assistant nurse does her recording in green ink. This is a very useful administrative device. They do not have any\ncars. As a matter of fact there are only eight agency cars for all of Toronto. \u00E2\u0080\u00A2\nThere are no special qualifications for the assistnat nurse except that she\nhave the certificate and that she be a mature person. This does not necessarily mean\nthat she be an older person. As a matter of fact, some of them are quite young. They\nstarted using assistant nurses in 1947 and took two on that summer. This last year\nthey increased the staff by three more.\nThe V.O.N, gives service to eleven small industries. One of them only has\nfifty employees and another one hundred and fifty, the rest have more. The amount of\ntime given to each varies. It is a fully paid for service. Miss ^eask goes goes in e\nto explain it to management. They indicate to them the type of service which they\nwill give,if management are only wanting first aid then they isiiiaaha: will not go\nin on that basis. They all must have a doctor either on call or on a part time basis.\nMost of them have it on the latter. The nurse does the interview before the physical ,\nexamination and the follow up. Most of the doctors want the nurse there at the time\nof the phsycial, but a few do this on other days and the V.O.N, rather likes it\nbecause it gives the nurse an opportunity to use her time in other ways. In the ,\nindustry they are doing quite a bit of work in nutrition. They will do first aid work\nwhile they are in but they try to minimize this. Each industry has standing orders\nwhich have been improved by the doctor aoot in charge. The V.O.N, drew up a sort of\nstandard and it is taken to each doctor, he may change it slightly.\nThey have an agreement with industry. All the nurses in industry have to be\npublic health. Two or three of them have taken the extra course at the university.\nThey can take this along with their regular public health nursing course, it consists\nof extra lectures and an extra month of field work. Miss Hfcix Milne supervisor in\nthe Runnymed office was the one who first started the industrial nursing and she is\nresponsible for the supervision of the industrial nurses in the eleven plants. The\nnurses send in a monthly report and one copy goes to Miss Milne (it would be a good\nidea when I have prepared the work on industrial nursing to have a small committee\n -157-\nconsisting of Miss Wallace, Miss Leask and Miss Milne at least.\nPre-natal - It would be a good idea to go to one of the cAAsses the V.O.N, teaches.\nMiss leask spike of the questionnaires which are sent out to the mothers to return\nabout two months after the baby is delivered. I can get information from Mrs. Park on\nthe response to these and I think this would be valuable. In relation to follow-up\nhome supervision of the pre-natals coming to the classes, all those who are carried by\nthe V.O.N, are given home supervision but not as frequently. It is believed to be the\npolicy of the Health Dept. not to visit those cases who corae to the pre-natal classes.\nMiss Leak and the other assistant Miss McNamara have been doing some work in\ntrying to eliminate non-essentials from the clerical work in the offices. It was found e\nthat the supervisors were having to do quite a bit of work which the clerks could do if i |\nthe clerks could be relieved from some of their work, so tiey undertook to make an analysis of this. This is a very good idea to suggest for all agencies. They did the work a\nby each of them taking three district offices and going to each and sitting with the\nsecretary for a day. Then Miss Leask and Miss McNamara brought back their findings and\nhad a conference on it. These are some of the things which they found and decided to n\nchange.\n1. It had been the policy to type out a family record after the nurse had visited a\ncase twice. The nurse had made a summary on the pink slip for the first and second\nvisits. It was found on examination that a great many of these cases were never referrec\nto again and it was wondered if this typing wasnot essential. It was decided that the f *\\nsupervisor would indicate which families should have a family record typed out and it\nhas been found that there are very few. They would suggest the typing for such cases\nas those that have been taken on the second time, ones where there is a problem and ones\nwhere they are going to do a long follow-up. This has eliminated a great deal of work.\nThey made a count in one district and found that there 1,000 of these records which\nhad never been referred to again for last year only.\n2. Regarding the examination of the laundry for tears. It had been the policy for the\nclerics to examine the laundry once a wefek as it came in for tears. It was also noted\nthat when a nurse takes out an apro^n she examines it too. Now the clerks only count\nit. This takes ten minutes whereas it took an hour to do the other.\n3. Instead of writing a letter to a doctor for order in relation to hypodermic therapy\nthey have a form letter and it is only necessary to type in the doctor and patient's name\nThis type of thing needs very much to be done by all health agencies.\nEfficiency Reports - These are made on supervisory wijwiirks visits and on box supervision.\nThe box supervision is really a supervision of records to find out the qulity of recording, district management, etc. The report is a narrative one. The examples are not\nput down but the supervisors must have them in readiness in discussing it with the nurse,\nso that if a nurse questions a statement made she will have her example right there.\nThey feel that the efficiency report! is a developmental process. There comes a stage\nwhen there is no material difference in development and it is not necessary to write a\nlengthy narrative report on the nurses who have been longer with the staff. This just\nmeans too much work.\nThe assistant nurse also has a narrative report, the headings are changed\nslightly for her. The nurses and the assistant nurses find their report.\nConference with Miss Palk. Educational Director.\n1 Work with the undergraduate students. They took 92 undergraduate students from the\nhospitals in Toronto last year. They came for four days each. This roughly one-quarter \\nof the students in Toronto. They will only take if there is a health supervisor on the\n -158-\nhospital staff to correlate the program. The introduction of these students is\ngiven by the district office and staff. They do not come to the central office for a\nconference with Miss Palk. Ituif-.usually the senior nurse who sees them. They are\nalso Prepared by the hospitel/superSisor and there will be a conference when they go\nback. They have centralized lectures from the Health Dept. and from the V.O.N. (I am\nto attend one of these and also the Health Supervisors' meeting following.)\n2. Students from the School of Nursing, Degree Course. These students have a half\nday in the first year and they also return for a half day in the second year. This is j\nfollowed later by more lengthy field work experience.\n3. Graduate students. These students come for one month in April, May or June. There'\nare about twelve each month. These are the ones who have taken the public health certi\nficate course. Those have never had any V.O.N, also have an observation visit in\nSeptember before they.nke the course, it is only for two weeks and it is purely observe\ntion. These students have about 20 hours of class which is largely discussion and\ndemonstration. They have first a period of observation and then they see in the class\nroom discussion , they supervision, then independent work then supervised. They remain |\nmostly with one field guide. They do not go to a child health centre or to industry.\nThe evaluation of the student is a cooperative effort on the part of the field guide\nand the senior nurse and the supervisor.\n4. The administration and supervisory group from the hospital. They have two hours\na week for four weeks conferences with Miss Palk and others on the central office staff]\nThere conferences are on administration, evaluation, student affiliation, etc. and\nthey are taken up from the point of view of the V.O.N. They do not yet have any field\nwork from the V.O.N.\nMiss Palk has two preparatory conferences with the staff before taking\nstudents. The first conference prepares them for taking students, the second is the\nactual plan for the students work, the writing of reports, etc.\nMiss Palk also gives one hour a week for twelve weeks at the University. The\ngroup is divided into conference groups where they each take up detailed work on the\nhome visit, Miss Palk acts as a guide in the pre-natal and post-natal visits. I think\nthey have seven sessions on this, giving six visits before and one visit after.\nStaff education program -\n1. The orientation of new nurses, this consists of an orientation period for (a) the\nassistant nurse. This is two weeks of observation and supervision, (b) junior staff\nnurse, this is the nurse who has not had her public health preparation. They have a\nclass a week over a period of two months. Miss Palk gives them from 30 to 35 hours.\n(c) The prepared public health nurse, the have a shorter introductory period for\nagency policies.\n2, Staff education program, they have on duty conferences at each district. One of\nthese to be seen. They also sometimes have during the year lectures in the evening\nwhich are off duty. These are usually followed up by planned on duty conferences.\nOn Thursday morning went to the Hillctest office of the V.O.N. Miss Grant is the\nsupervisor and Miss Watston is the senior nurse. Many of the things which I Bicuss-\ned with Miss Watston were things alreddy discussed with Miss Leask. In referring to\nthe efficiency report Miss Grant said that that was the hardest thing that she had\nto do but she would not want any other kind, would not like the check system. She\nsays in going out on fche supervisory visits with the nurse she is following a suggestion made by Miss Palk. She takes a sheet of paper and divides it into two. The\nleft half is headed\"situation observed\" and the right half \"visit observed\". This\nshe feels is a very effective way of writing down an objective account of the\n -159-\nobservations. If it is an educational visit she will write down in \"situation observed\"\nthe actual situation in the home, type of instruction to be given etc., and may note\ndown the questions asked by the mother.\nIn asking her what she felt about the didfferences between the public health\ntrained nurse and the non-iublic health trained nurse, she said that there' are some who\nhave not had their public health training who are excellent people. She feels it\ndepends on the xxix individual. The nurse must be interested in people and she must be\nable to make them feel that they are important. She recalled one nurse who did not have\npublic health training who was able to do this. By and large the public health trained\nperson is much better, especially on the educational part. ,\nIn the morning went on two visits with Miss Stevenson. She is a young nurse\nwho graduated from the university of Toronto course last September and came on with the\nV.O.N, then. She is very much in mxaaxk earnest about her work. The first visit we\nmade was to a mother with a young baby. The nurse had given the demonstration bath the\nprevious day and on this day the mother returned the bath. She took the opportunity for\nteaching but was perhaps a bit over-enthusiastic to get in as much as possible. The\nnext visit was to a family on Richmond St. where a little girl of ten had had a severe\nburn. She had been in hospital and now was home and the V.O.N, had been asked to go in\nto do the dressings. This was a very difficult type of situation. There was not a\nvery large income and the nurse had felt that the mother certainly did not know how to\nspend her monAy wisely. It seems that this was only the second visit and I noticed that\nshe tried to get ii^ some teaching about budget. She asked me when we left if I thought\nthat it was a very successful teaching situation. I felt that it was one of those cases\nthat we just have to let go on and perhaps after a long contact something might be done,\nbut not on such very short contact.\nTn tal&Agg with Miss Stevenson about the course she seemed very enthusiastic\nabout the integrated program. She said that she did not see how the girls who take the\nthree course and then the year in public health, can get in all the information needed\nin public health. She feels that by taking it over the longer period they have a chance\nto absorb it. She was quite enthusiatic about the nutrition classes given by Dr. Btaakix-\nxra Robertson. She felt however, that even though there was someone budgetting there\nwas not enough of the practical work. They seem to feel weak in this. This probably\nan area where there would have to be increased in-service training, where the nurses\nfeel the deficiency as it is rather hard to get it in apparently, int the lectures. She\nfelt that they did not have quite enough on social case work to enable them to recognixe\nthe problems and to use the available resources in the community. This, however, I\npointed out was something which came with experience. That the university could not\nteach them all the resources in the community in which the nurse was going to work\nbecause the studeAts come from so many different communities and would be going back to\nso many different ones.\nOn Friday morning went to the Hillcrest office where Miss Milne is the supervisor. Miss Milne also supervises the industrial nurses or rather the V.O.N, nurses\nwho are doing work in industry. I arranged to visit with one. (See report later) The\npurpose of my visit to this district was to go out with Miss Holland, one of the nursing\nassistants. Miss Holland is the first one to be taken on by the V.O.N, and has been with |\nthem for about two years. She seem to be an extremely capable girl and seems to fit in\nwith the rest of the staff very well. I noticed that the nurses were talking to her and\ntreated her just as one of themselves. The green uniform is very attractive. I made\ntwo visits with Miss Holland, one was to an elderly lady with arthritis whom she visits\nevery day to get up out of bed. The second one was to a senile case where she goes\nthree times a week to give a bed bath. I did not observe Miss Holland's technique too\nclosely, I think perhaps she slipped on some of the nieceties of it. I noticed that\nshe put her bag down without first having a newspaper, which you rarely see a graduate\nnurse in the V.O.N, service doing. I thought that perhaps she was a little rough ln\n -3.69-\ngiving the bed bath but the patient seemed ir like it and no doubt this roughness is\nnot a quality she had because she was a nursing assistant and not a graduate nurse. I\nhave seen graduate nurses who have been equally rough. She seems to like the work, on\nthe other hand she said that when she took the course she knew that she would have to\nwork with elderly people and she just made up her mind to like it. She will probably\nnot want to carry on indefinitely and she feels that you do get into a rut doing this\ntype of thing. She would like to work in a general hospital.\nOn Monday, March 21st attended a staff education conference at the central\noffice area of the V.O.N. All the nurses came in for tea at a quarter to four and then\nsat around the table for a meeting. They do not have these conferences at regular interv |\nals. This is one of a series of two or three, based on questions asked by the nurses.\nThese were problems with which they were having difficulty. They related to the scope\nthey had in advising regarding the giving of orange juice and cod liver oil, changing\nof formulas etc., in their home visits. Also in relation to pre-natal, post-natal\nteaching. It was brought out in the discussion that the pre-natal welfare visit to the\nmultipara can be very challenging if especially if it is the intelligent woman . The\nnurse has to have something new for each visit and has to keep reading all the time. It <\nreally takes the best the nurse has and keeps her on her toes. Such visits to the\nmultipara can deal more the relationship of the new baby to the child already in the\nhome and can have more of the mental hygiene aspects of the pre-schools. Then there are\nalways new things being discovered and new articles being written. This material can\nbe used for such health instruction visits.\nAgain the importance of manual rnxxxxxttax expression of breast milk was\nbrought up. This is one of the most important things in helping to return the supply\nof milk if the mother is beginning to lose it. Miss Palk led the discussion and I\nnoticed of all the nurses present, only one did not make any contribution and I discover- |\ned at the end of the meeting that she had just been at the agency for a couple of days.\nThis seemed to be very good.\nOn Wednesday, the 23rd, attended a pre-natal class at 44 St. George St, Miss\nWatson of the Hillcrest Unit had charge of this class. She had twelve mothers and her\nclass was on breast feeding largely. Miss Watson had quite a different manner from Miss\nBale and I think perhaps a nore preferable one. I believe there was more discussion\nfrom the group in her class. I noticed the mothers stayed for a long time afterwards\nand had many individual problems to bring up with her. I looked over the manual of prenatal instruction which has been prepared by the Community Chest group for the pre-natal\nclasses, it states very definitely that this is a guide and the individual can vary it.\nThis is the outline which they gave -\nClass 1 (a) General introduction\n(b) Nurses introduction\n(c) Nutritionist, importance of pre-natal diet.\n(d) Librarian, available literature in public libraries.\nClass 2 How the baby grows\nClass 3, Food before the baby comes ( Part 10\nClass 4 and 5 - Hygiene of pregnancy\nClass 6 - Food before the baby comes (Part 2)\nClass 7 - Equipment for the baby\nClass 8 - Feeding and dressing the baby\nClass 9 - Food after the baby comes\nClass 10 - Child development.\n /o/\nV.O.N. Industrial Service. Toronto.\nWent one afternoon with Miss Highmoor to the Highland Dairy on Ontario St.\nThis dairy has about 250 employees. Miss Highmoor is there from 2-5p.m. every Wednesday afternoon. Dr. Bell is the usual but for the past few months his place has been\ntaken feHxxaxy by a young doctor from the Toronto Western Hpl., Dr. Calvert. I\nbelieve the doctors usual hours are from 2.30 to 4.30. This means that there is very\nlittle time when the doctor is not there for the nurse to interview employees- or to do\nany of the follow up work. She is a bit worried about how this can be planned. Tho\npolicy is to do a pre-employment or at least a so-called pre-employment but it is done\ntwo or three months after the employee is taken on and they also do periodic annual\nexaminations. Dr. Calvert did three women when I was there. I talked with him afterwards about whether or not such examinations, which admittedly were not complete\nphysicals, were giving a false sense of security to the people. He did not feel so. I\nquestioned in relation to the policy about x-ray. It is not routine to have x-rays.\nAnd they do not even ask it of the employee Before coming on. I questioned this and I !\nbelieve Dr. Calvert agreed. They did have a mass survey last year and were more or less|\nfeeling that that was sufficient.\nMiss Highmoor took the special industrial lectures at the University of\nToronto along with her public heatlh nursing. She feels that they were very valuable\nand that they enable her to do a much better job in industry. As observed on Wednesday,|\nI felt that she was not doing an awful lot more than assisting at the medical examinations. She got the patient ready, taking part of the history and then prepared the\nsyringe for the taking of blood for the Wasserman and haemoglobin. The doctor took the\nblood. She checked the haemoglobin. She also did the urinalysis after the doctor had\nleft.\n IL.\n "@en . "Only pages with writing were imaged. Appears to be her full personal record of the Baillie-Creelman Survey."@en . "Diaries"@en . "ARC-Creelman-2-4"@en . "creelman_02_04_01"@en . "10.14288/1.0214446"@en . "English"@en . "Vancouver : University of British Columbia Library"@en . "Digital copies are provided for research and personal use only. For permission to publish or otherwise use this material contact the UBC Archives at lib-ubcarchives@lists.ubc.ca"@en . "Original format: University of British Columbia. Archives. Lyle Creelman fonds. Diaries and logbooks. ARC-Creelman-2-4"@en . "Nursing"@en . "[1948-1949 Diary Hamilton Ontario]"@en . "Text"@en . ""@en .