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THE GREAT War, lasting four years,
began as a result of Archduke Ferdinands
assassination in Sarajevo on June
28 1914. A century later, we reflect on
the challenges that confronted the nurses
practising at that time.
Much is written about those nurses
who demonstrated extreme bravery caring
for the injured in field hospitals close to
the front line, but little is known of those
who held the fort at home. District nurses
faced considerable challenges of their own.
They were pillars of their communities,
but for different reasons.
Understanding the Liberal governments
reforms from 1906 to 1914, just before the
Great War, is important when reflecting
on any medical care at the turn of the
20th century. In passing educational acts
and public health laws, the government
discredited any notion of laissez faire,
or the policy of non-intervention in relation
to social problems. Although poverty
posed many challenges for nurses, the
steps taken towards the provision of basic
welfare enhanced the development of
the nursing role.
In 1907, the first hints of school nurses
were introduced with the Childrens
Charter. School medical inspections
were made, with free medical treatment
provided from 1912.
Nurses working with schools through
the war cared for children whose fathers,
or older brothers, may have fought, or been
killed, in action. Childrens health at school
was further enhanced when, in 1914, school
meals were made compulsory following
public health research that found childrens
growth was poor and bodyweight low.
During the war, the government
also tried to enforce an act protecting
children from the effects of tobacco and
alcohol, but this had limited success.
Community nurses in the 21st century
continue to fight the same battle.
Health and nursing care was further
boosted by the National Insurance
Act 1911. A worker paid fourpence a week,
an employer threepence and the state
twopence. This provided an entitlement of
sickness benefit of nine shillings (45 pence
in todays terms), free medical care and
a maternity benefit of 30 shillings (1.50).
Unemployment insurance was given for
a maximum of 15 weeks for the amount of
seven shillings (35 pence), but health care
did not extend to the family.
When long-term unemployment during
and after the war rose, the system began
to break down through lack of funding.
This may have increased the workload
of community nurses and caused them
emotional concern and upset in cases
where there were limited funds to treat
those in need.
According to the National Public Health
Archives, there were an estimated 2,019
community nurses in 1914, but the move to
register nurses was not without controversy.
Rosalind Paget ensured that there was a
registration for midwives in 1902, but the
Nurses Registration Act was not introduced
by the General Nursing Council until after
During the war, community
nurses acted with autonomy,
they worked extraordinarily
long hours and pushed the
boundaries of their role
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Unsung heroes of the Great War
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the war, in 1919. This ensured all future
nurses were properly trained and registered.
Historians debate whether it was Florence
Nightingale who delayed the act. She was
deeply opposed to nurses being supervised
by anyone other than a senior nurse.
Although the exact details of community
nurses working during the war are limited,
we know that they were not supported by
non-qualified nurses because this role was
introduced to the profession about 30 years
later in 1943, when a national shortage of
nurses was declared.
We also know that community nurses
were responsible for their own teams and
resources, because support from local
county councils did not come until 1948.
Once the war began, medical staffing
at home reduced by half, but with the
expectation of providing essentially the
same core services as they provide today.
Nurses working in the community cared
for children, lone pregnant women, older
people and soldiers discharged from the
war through ill health. They also provided
midwifery, health promotion in particular
encouraging a healthy diet and
palliative care.
They also attended to women whose
health was affected by jobs usually
undertaken by men. The huge numbers of
men needed to fight the war resulted in
women being employed as gas workers,
coal heavers, transport workers and
ambulance drivers among other jobs.
During the war, community nurses acted
with autonomy. They had little support and
few resources to treat ever-increasing need.
They worked extraordinarily long hours and
continually pushed the boundaries of their
role. They are perhaps the unsung heroes of
the Great War, caring for the nation at home.
But the work of a nurse is never done.
In 1918, when the war ended, a new battle
began against the influenza pandemic.
More than 500 million patients were
affected worldwide. Our role will never be
extinct and there will always be a fort to
be held at home.
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Book review
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17-year-cld Dicnne, 15-year-cld Sarah and
20-year-cld Lcuise the reader is taken cn
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The guide is packed with infcrmaticn,
but is easy tc read and illustrated in a fun,
cclcurful cartccn fcrmat. t will appeal tc all
readers, but may be beneficial especially fcr
thcse with literacy difficulties.
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cf pregnancy cr childbirth and gives clear,
succinct explanaticns alcng with pictures and
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health fcr the parent and unbcrn child, and
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pregnancy and childbirth. Pictcrial checklists,
such as the hcspital checklist, enccurages
mums tc tick the circles when they have
purchased and packed all essential necessities.
This bcck takes a pcsitive apprcach tc
pregnancy and childbirth and wculd be useful
fcr health and sccial care prcfessicnals wcrking
with pregnant ycung wcmen and ycung
parents. This handbag-size guide is the perfect
ccmpanicn tc helping ycung mcthers-tc-be
'993++ '42*93 ',4 *,-./0'1*., ., 1:3 6.<
Joanne Seal is a senior lecturer in specialist
community public health at the University
of the West of England, Bristol
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A lonely lesson learned
@ ABC? (33, /30*,*+9*,6 '(.51 +.03 +739*';
patients. Stella, 78 hypertensicn, heart
disease and diabetes was a team regular
with lcng-standing leg ulcers. A sweet, gentle,
childless widcw lcved by all, but she was
hcusebcund with cnly Bud the flccr mcp
(ckay, a dcg whc lccked like cne) fcr ccmpany.
My new nurse Dcttie was clever and
enthusiastic sc asked her tc assess Stella.
She learned mcre than anticipated. After
twc weeks, Dcttie was trcubled. ' think Stella
is intenticnally neglecting her health. She is nct
taking her tablets cr insulin prcperly but says
she is, and the bins are full cf sweet wrappers.'
We spcke tc the 0P, whc said we were
'cver-reacting'. 0cncerned, we started daily
visits, assessed fcr dementia, administered
medicaticns, checked her legs and mcnitcred
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Three weeks cn, Stella's legs and health
were imprcving, sc we gradually reduced
visits frcm daily tc twc weekly. Then Stella
repcrted a new ulcer. She knitted while Dcttie
assessed her. 'Well, ycu will heal quickly,'
Dcttie said. ' am nct ccnvinced,' replied
Stella. Then Dcttie ncticed blccd cn the
knitting needle. She reached fcr it but Stella
tucked her knitting away, saying. 'Mind ycur
cwn business.' Stella called me after Dcttie
left tc say. 'Dcn't send that nasty girl here
again!' An upset Dcttie said. ' am certain
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We met at Stella's hcme the fcllcwing
week with the (ncw ccnvinced) 0P and sccial
wcrker. The intrcductcry, 'Stella, we are wcrried
abcut ycu', led tc a lcng discussicn ending with
an admissicn that 'maybe' she did nct always
take her tablets and she 'scratched' her legs a
bit. 'Why!' the 0P asked. Stella brcke dcwn. 'f
get better, will be alcne. used tc have a life,
ncw cnly ycu visit me. Dcttie, am sc scrry.'
D3 /3-3//34 :3/ 1. 1:3 4') 93,1/3 ',4 1:3
senicr club, with transpcrt, where she fcund
friendship, purpcse and the will tc get better.
But with these services ncw all clcsed, hcw
cculd we have helped Stella! sn't terminal
lcneliness deserving cf palliative care!
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