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Walk down memory lane with the QNI on nursing in the community

To mark 150 years of community nursing, the Queen's Nursing Institute has produced an awe-inspiring collection of accounts, rare footage and old photographs from the people who were there 

To mark 150 years of community nursing, the Queen's Nursing Institute has produced an awe-inspiring collection of accounts, rare footage and old photographs from the people who were there 


A district nurse leaves instructions on the door in the 1950s. Picture: QNI

On flickering black and white film, district nurses are seen weighing babies, arriving at country cottages surrounded by cows and demonstrating how to wash a baby in front of a fire.

This rare footage from 1935 shows Queen’s Nurses’ daily work, including a nurse leading a dental and handkerchief hygiene session in a school playground for dozens of children. Usually arriving on bicycles, the nurses wear hats and uniforms, and carry solid black bags.


Picture: QNI

The footage is part of Queen’s Nursing Institute (QNI) Heritage, a new interactive website charting more than 150 years of community nursing. Containing recollections of nurses, rare film and old photographs, the website is a growing archive recording a long and proud history.

The site, supported by the Heritage Lottery Fund, includes photographs of district nurses caring for hop-pickers in the fields of Hereford in the 1940s, and visiting travellers sitting outside their traditional wooden caravans. A nurse is photographed assisting a doctor performing a tracheotomy on a child with diphtheria on a kitchen table, while another is pictured on a rural visit standing beside a woman finding water from a well.

Timeline

1859

William Rathbone, a Liverpool merchant and philanthropist, had employed a nurse to care for his wife at home. After his wife’s death, he retained the nurse’s services so that people in Liverpool who could not afford to pay would benefit from care in their own homes. When too few trained nurses could be found, Mr Rathbone set up and funded a nursing school in Liverpool specifically to train nurses for the 18 districts of the city.

1860s and 1870s

Other large cities start setting up their own nursing programmes, including Manchester, Derby, London, Glasgow and Dublin. Poverty was rife in these cities, with malnutrition, poor housing and unclean water leading to health epidemics.

1887

The Queen’s Nursing Institute was established with a grant of £70,000 from Queen Victoria. It had the objectives of providing the ‘training, support, maintenance and supply’ of nurses for the sick poor, as well as establishing training homes and supervising centres.

1947

First male district nurses start training.

1948

The launch of the NHS means free access to district nursing for all.

1968

The QNI stops training nurses.

2007

The QNI reinstates the title of Queen’s Nurse after an absence of 40 years. Community nurses who have at least five years’ experience can apply for the title.

In a 1974 fundraising film made by the QNI, a district nurse cycles ten miles around east London visiting 15 patients at home, including an older woman in a tower block and a patient in a terraced house who has had a lung removed.

Charting and celebrating

Matthew Bradby, QNI head of communications, says the website helps chart and celebrate the particular role of district nursing. ‘These nurses have incredible levels of dedication and commitment to their patients, and that is what we see consistently,’ he says.

‘The development of district nursing is really interesting, and the website is creating a coherent story about district nursing and community nursing, and how it developed over a long period of time.’

Community nurses, often pictured struggling through snow or cycling miles to patients, hold a particular place in patients’ memories, Mr Bradby says. ‘The relationship with a district nurse is one that most people have a positive recollection of.

‘If someone is receiving visits from a nurse at home then their relationship is completely different to the one you would have in a hospital. If you are visiting a patient at home, district nurses always say that you are a guest in that person’s home.

'You have to have a collaborative relationship, working with the patient to find solutions to their healthcare needs.’

The beginning

District nursing began in 1859 in Liverpool, when merchant and philanthropist William Rathbone continued to employ the nurse who had cared for his dying wife so that others could benefit from care in their homes.

Mr Rathbone and Florence Nightingale worked together to try to develop the service. When too few trained nurses could be found, Mr Rathbone set up and funded a nursing school in Liverpool specifically to train nurses for the 18 districts of the city, and ‘district nursing’ began.

Before the NHS, organisers of local district nursing associations were responsible for employing district nurses and paying their salaries, building homes for them to live in, and other expenses. These organisations spread rapidly across large cities, where poverty and the diseases caused by malnutrition and lack of sanitation were rife, in the 1860s and 1870s.

These local associations undertook fundraising to meet their outgoings and a large majority of the associations were affiliated to the QNI, which began in 1887 and provided training.

People would often pay a subscription to the local association to cover the costs of their care when the need arose. The nurses would need to get payment for their visits if this was not the case.

Asking patients to pay

Irene Sankey, a district nurse in Brighton in the early 1940s, has written on the website about how difficult it was to ask for the fee. ‘One aspect of my training I disliked intensely was collecting money. The NHS was eight years away… so patients who could afford it were asked to pay. I found it embarrassing and distasteful, asking them about their income and expenditure.’

District nurses were one of the key elements of the new NHS when it was launched in 1948. For the first time everyone had free access to nursing in their homes. ‘It was a real relief to nurses then that they didn’t have to ask their patients for money,’ Mr Bradby says.


Picture: QNI

For much of the 20th century, district nurses were usually unmarried women who lived in nurses’ homes, provided by local nursing associations all over the country.

Many also undertook training in midwifery and health visiting, and would provide elements of all these professions when caring for patients. Basic education on public health, such as the importance of cleanliness and sanitation, were central parts of the community nursing role.

Susan Cohen, an independent researcher who has written two books on the history of district nursing, says these women were vital health professionals in their communities.

‘In the past the district nurse seems to have become almost part of the family and privy to the sorts of intimacies that other healthcare professionals wouldn’t have.’

Male district nurses

While district nursing was an exclusively female profession for more than eight decades, men were permitted to start training as district nurses in 1947.


QNI's Geoff Hunt in 1952, five years
after men were allowed to train as 
male nurses. Picture: QNI

DJ Gillet was one of the first four to train and recalls on the QNI Heritage website that he faced little prejudice, although he was only allowed to nurse men. ‘When once it is realised I am not the insurance agent or an intruder, I am always welcomed,’ he writes.

While he was doing his six-month district nursing training he lived in a nurses’ home in Leicester. ‘It was well equipped with an excellent lounge, reading room and dining room,’ he says. ‘These were pleasantly furnished and always richly decorated with flowers.’

The QNI is keen for the interactive website to evolve and anyone who has worked in the community is encouraged to share their experiences. This could be written accounts, photographs or oral recollections.

The online archive comes at a time of growing concern about the district nursing workforce. District nurses were one of the key elements of the new NHS when it was launched in 1948 and remain a fundamental part of the health service, Mr Bradby says.

Despite this between 2010 and 2016 the number of full-time equivalent qualified district nurses in England fell by 46%, according to the QNI.

‘Through the history of district nursing we can see how important they are to the effective running of the NHS. But if we don’t properly invest in the district nursing workforce, one of the risks we have is increasing pressures on other parts of the NHS, including on GPs and hospitals,’ Mr Bradby says.

Case study: London district nurse

Zena Edmund-Charles, who was born in Jamaica in 1932, worked in the 1960s as a community midwife before becoming a district nurse in Leytonstone, north-east London.

She lived in the nurses’ home, where staff also held clinics, and visited her patients on her bicycle.

‘Types of care given included daily washing, morning and evening wash and put to bed, administering insulin, changing dressing to wounds, attending to glass eyes, administering iron injections, giving blanket baths, visit to observe patient management and bereavement visits, and giving enemas,’ she writes on the QNI Heritage website.

Care was provided to the highest standard. ‘Nurses were trained to respect and care for every aspect of advice, care, prevention, discussion, and teaching.

'We had to be sympathetic, show understanding and most of all always be ready to listen to what the patient was saying. When the weather was cold, nurses would spend time to rake and light the fire, also make the breakfast – maybe of toast, cereal and a cup of tea. On some Sundays and bank holidays I would cook and take a hot meal for my patient.’

 

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