Public Health Nursing in the Settlement House

Our collection includes a series of reports from the the Henry Street Settlement House, one of the many settlement houses that sprang up across the United States at the end of the nineteenth century and the beginning of the twentieth; some still survive, although in vastly different form.

The Henry Street House was in New York City, in a thickly settled district largely populated by immigrants and transient population. This particular settlement house was more than one building; the reports show that activities took place across the district. The visiting nursing service was established by Lillian Wald and Mary Brewster in 1893. Both Wald and Brewster were graduates of the New York Hospital Training School. It’s important to realise that both Wald and Brewster had no need to support themselves financially from their nursing work; they both had family resources to draw on and a degree of independence unusual for women at the time.

Nursing was still a new profession and nursing outside of a hospital setting generally restricted either to missions or to patients with private means who could hire a nurse to come to their home. Wald, Brewster, and others suggested a nurse associated with a particular district or, in this case, settlement house, who would be available to any resident of the district for any reason. Residents wouldn’t need to come to a clinic, they could be visited in their homes. The nurses not only functioned as nurses, medical professionals, but also as agents of cultural assimilation, demonstrating “American ways” to immigrants. Visiting nurses could and did take care of the sick, but they also tried to refer people back to the settlement house or relevant city services for things they did not provide, such as language classes or naturalization services. They also demonstrated in themselves what were felt to be some key American values: cleanliness, punctuality, preparedness. The Henry Street reports also show that visiting nurses were involved with the medicalization of motherhood, holding classes and teaching women ‘how to be mothers.’

The reports are a fascinating window into late nineteenth and early twentieth century America.

Teaching Nursing on the Ward

Black and white photograph of two women in nursing attire sitting facing each other at a narrow table. Text on the photograph reads: "The individual conference gives an opportunity for guidance."

Anna M Taylor’s 1941 Ward Teaching: Methods of Clinical Instruction is as detailed a breakdown of clinical nursing education as you could wish to see. Taylor takes the instructor or program manager through every step of setting up and executing a course of clinical instruction, right down to how to introduce a new nurse into the group and a list of seven factors that will determine the success or failure of a group conference on a single patient’s care.

Printed form for tracking nursing students.

Taylor is interested in every aspect of the instruction process and goes so far as to provide blanks of the forms she recomends; for example, this one for an individual conference between the student and head nurse. Taylor suggests a 30-minute format for these meetings, with the first five minutes spent on “establishing the tone of the conference.”

With a publication date in 1941, it’s difficult to tell from the volume itself whether it was printed before or after America’s entry into World War II, but Taylor’s prose certainly has a wartime efficiency feel to it, perhaps already inspired by efficiency studies of the 1920s and 1930s. There’s no time granted for chat, small talk, or any kind of work relaxation. Taylor’s nurses are on task one hundred percent of the time and not just with each other but, by implication, with the patients as well.