Transcript Ordered to Care - College of Education

Ordered to Care
CHAPTER 2
CHAOS AND ORDER IN HOSPITAL NURSING
19th Century Hospitals
 Institutions for sick, poor, or displaced members of
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the lower working class.
1873 – 120 hospitals in the country
Hospital Nurses were at the very bottom of the paid
labor hierarchy
“Professed “ nurses became members of a
household for the duration of illness
Hospital Nurses were confined to the institution as
their home and workplace.
Early Hospitals
Voluntary Hospitals
 Established through charitable efforts of middle and
upper classes
 Intended for deserving and respectable poor who
were ill
 Space was reserved for those that could pay for care
 Rooms for paying patients had nice furniture and
drapes.
Early Hospitals
Public Institutions
 Served Chronically ill & those with venereal diseases
 Harpers Weekly 1860 drew attention to problems
with filth, vermin and cross infection in hospitals
 Rampant cross infection was called “hospitalism”
 Benevolence did not equate to cleanliness
Early Hospitals
 Seen as a home or household
 Strict order was expected
 Rigid Rules for behavior
 Daily hours and visiting was regulated
 Tobacco and Liquor consumption was limited
 Dietary restrictions were imposed if rules violated
 Punishment cells were used
 Rules were constantly broken and easily ignored
Hospital Authority Structure
 Trustees ( Usually Male) controlled daily activities
 Main responsibilities were financial:
 Admissions
 Pay rates
 Extensions of Free care
 Screening out of incurable patients
Hospital Authority Structure
 Hospital Superintendent:
 Ordered supplies
 Hired and fired servants
 Hired and fired nurses
 Oversaw running of institution
 Frugality was expected and skimming of funds
common.
 Matrons (usually superintendants wife) was
responsible for overseeing the cooking , washing and
cleaning.
The Hospital Nurse
 Lived at the hospital
 Patients and caregivers are the same
Patient
Kitchen
Help
Nurse
Laundress
The Hospital Nurse
 Poor, working class
 Hospitals would hire anyone for the position
 Courage, self- possession, and snap
 Frequent staff turn-over
 Nurses and patients were not separated.
 Cleaning and laundry were typical tasks
 Worked from 5AM- 9:30PM
An Order of Their Own
 Small hospitals- matrons directed the nurses
 Large hospitals- head nurse guided the state of the
unit
 Physicians and Nurses
The Rights of Caring
 Hospital management attempted to control the
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nurses’ lives.
Home care, institutions, or another profession
Culture of nurses
Caring was rare
Autonomy
Transformation Needed