Assignment: Dominant Philosophical Schools Of Thought In Nursing

Lillian Wald, Public Health Nursing, and Community Activism The pattern for health visiting and district nursing practice outside the hospital was similar in the United States to that in England (Roberts, 1954). American cities were besieged by overcrowding and epidemics after the Civil War. The need for trained nurses evolved as in England, and schools throughout the United States developed along the Nightingale model. Visiting nurses were first sent to philanthropic organizations in New York City (1877), Boston (1886), Buffalo (1885), and Philadelphia (1886) to care for the sick at home. By the end of the century, most large cities had some form of visiting nursing program, and some headway was being made even in smaller towns (Heinrich, 1983). Industrial or occupational health nursing was first started in Vermont in 1895 by a marble company interested in the health and welfare of its workers and their families. Tuberculosis (TB) was a leading cause of death in the 1800s; nurses visited patients bedridden from TB and instructed persons in all settings about prevention of the disease (Abel, 1997).

Lillian Wald (Figure 1-2), a wealthy young woman with a great social conscience, graduated from the New York Hospital School of Nursing in 1891 and is credited with

BOX 1-1

creating the title “public health nurse.” After a year working in a mental institution, Wald entered medical school at Women’s Medical College in New York. While in medical school, she was asked to visit immigrant mothers on New York’s Lower East Side and instruct them on health matters. Wald was appalled by the conditions there. During one now famous home visit, a small child asked Wald to visit her sick mother. And the rest, as they say, is history (Box 1-1). What Wald found changed her life forever and secured a place for her in American nursing history. Wald (1915) said, “All the maladjustments of our social and economic relations seemed epitomized in this brief journey” (p. 6). Wald was profoundly affected by her observations; she and her colleague, Mary Brewster, quickly established the Henry Street Settlement in this same neighborhood in 1893. She quit medical school and devoted the remainder of her life to “visions of a better world” for the public’s health. According to Wald, “Nursing is love in action, and there is no finer manifestation of it than the care of the poor and disabled in their own homes” (Wald, 1915, p. 14).

Figure 1-2 A photo of Lillian Wald, taken by Harris and Ewing during the first half of the 20th- century.

Courtesy of Library of Congress, Prints & Photographs Division, photograph by Harris & Ewing, LC-DIG-hec-19537.

LILLIAN WALD TAKES A WALK

From the schoolroom where I had been giving a lesson in bed-making, a little girl led me one drizzling March morning. She had told me of her sick mother and gathering from her incoherent account that a child had been born, I caught up the paraphernalia of the bed-making lesson and carried it with me.

The child led me over broken roadways . . . between tall, reeking houses whose laden fire-escapes, useless for their appointed purpose, bulged with household

goods of every description. The rain added to the dismal appearance of the streets and to the discomfort of the crowds which thronged them, intensifying the odors, which assailed me from every side. Through Hester and Division Streets we went to the end of Ludlow; past odorous fish-stands, for the streets were a market-place, unregulated, unsupervised, unclean; past evil-smelling, uncovered garbage cans. . . .