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An Introduction to Volume 13 E xtending Nursing takes up the story of Nightingale’s work on trained nursing from its beginnings at St Thomas’ Hospital in London in 1860, of her mission to improve nursing everywhere it was possible to do so. Here we see the extension of trained nursing first to other hospitals in London, next throughout England and Wales, and then into Scotland and Ireland. Matrons trained at the Nightingale School took the new standards and procedures they learned wherever they went. The new matrons often consulted Nightingale before setting off and went back to her for advice as problems developed. Many would require concerted help in managing dif- ficulties with their hospitals. Nightingale provided respite care and sent food and flowers. The volume also contains correspondence with a variety of philanthropists and reformers who reported failed attempts at starting trained nursing. The extension of Nightingale methods into Europe and elsewhere in the world began soon after her first attempts to establish trained nursing in England. This volume contains considerable correspondence on efforts to bring trained nursing into Sweden, Germany, Australia and Canada, and lesser amounts for other countries. By late in Nightingale’s life, training schools based on her principles were also being established in France and Italy. After this massive amount of material on regular hospital nursing comes a section on workhouse infirmary nursing. After the considerable material on regular hospital nursing comes a section on workhouse infirmary nursing. The beginnings of her efforts on this subject have already appeared in Public Health Care, where the political work necessary to provide the legal, administrative and financial framework needed is reported. Here, the focus is on nursing practice and training. Since Nightingale’s goal was a massive transformation of hospital nursing, it should not be surprising that she was planning an extension of nursing training even before the school at St Thomas’ opened. / 1 This was for the establishment of midwifery nursing at King’s College Hospital. Nightingale had herself planned to become superintendent of nursing at King’s when the Crimean War intervened; that is, her appointment had been negotiated there (though not announced) and she had already given notice at the Establishment for Gentlewomen during Illness. While the groundwork for workhouse infirmary nursing has already been laid in Public Health Care, there is still much to report here. Nightingale’s intentions for workhouse nursing were always to have the nurses in workhouse infirmaries reach the same high standard as regular (i.e., paid) civilian hospital nursing. There were a number of obstacles in Nightingale’s way, notably the legal status of workhouse infirmaries, which were funded by local taxes (the rates), and had a different administrative structure from that of the voluntary hospitals. Recruitment of nurses was also more difficult, for reasons that will be obvious. Progress was slow and serious setbacks were experienced whenever a key matron departed or died. In the cases of Liverpool and Highgate , adequate replacements for the matrons could not be found at all. For training purposes, certainly, those able matrons were irreplaceable. The last substantive section in Extending Nursing is on district nursing , not last in importance or chronology. District nursing was a collective way to provide nursing care, short of a full-time private nurse, to those without the means to hire their own. Nightingale was approached by William Rathbone as early as 1860 for help in providing nurses for the sick at home in Liverpool. She always preferred nursing at the patient’s home, for hospitals were (and remain) dangerous places. Yet district nurses had to be trained in a hospital as much as hospital nurses, for only there would they be able to see an adequate number of serious cases. In some respects, Nightingale believed, district nurses had to meet a higher standard of competence, for they had no doctor on hand from whom to seek help (doctors called on patients at home, but the nurse might not be there when he came). Indeed, the major advocate of district nursing in Nightingale’s time, Florence Lees, stipulated that only ‘‘gentlewomen,’’ i.e., educated women, could become district nurses in her association. The volume ends with biographical sketches of major leaders in nursing. To recap the material in the series to date: the first volume to focus exclusively on nursing, The Nightingale School (vol. 12), relates Nightingale ’s preparations for nursing and her early work as superintendent 2 / Florence Nightingale...


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