BMJ Reports on the Nursing and Administration of Provincial Workhouses and Infirmaries, 1894-5.
In 1894-5, the British Medical Journal — as part of a campaign to improve the nursing and medical facilities in workhouse infirmaries — conducted site visits to around fifty workhouses in England and Wales. Below are extracts from their report on the Barton Regis union workhouse.
We visited this workhouse one lovely morning when sunshine and balmy air made even unattractive places pleasant. We found all the buildings low pitched, and most of the wards separated from each other by yards. As these are made bright by flowers and creepers. they serve a good use as gardens and outdoor sitting places for the infirm, convalescent, imbecile, etc., who can step out of doors whenever they wish to do so without contravening rules or causing disorganisation. This habit of running out of doors at any moment without preparation is one that the poor have been accustomed to all their lives, and to obtain it for them in the workhouse infirmaries is no slight gain, and should be taken into consideration in weighing the disadvantages of the divided ward or hut system. We learnt that it was now some years since the Barton Regis guardians have done any building, as they were waiting for the amalgamation of the three unions, which in its turn awaits the decision of the question of the extension of the city boundaries, the latest addition in 1879 being wooden buildings designated "pavilion wards." These have thorough ventilation, lofty roofs, and are well supplied with large windows. All the sick wards, notably those on the women's side, are hung with bright curtains, contain pictures, flowers, etc.; and we have seen few more satisfactory sights than the day room for infirm women, where they sat, sewed, looked at periodicals, tended the growing plants, and were made happy by the possession of a sofa and the boiling of the kettle for the making of "their own" afternoon tea. The lady guardians and the matron unite in wishing that the compulsory last home of those who are driven into the "House" by their infirmities should be as homelike as possible, and the absence of quarrelling and the kindly ways of the old dames showed they had succeeded. In some of the other wards for aged and infirm, where there were many patients confined to bed, we were not, however, so satisfied. Though we were pleased with the bright energy and good spirit shown by the nurse we saw, we yet think that the number employed is inadequate for the patients under attention.
To serve 120 infirm women located in seven wards there is but one nurse by day and no night nurse, the day nurse being called out of her sleep should occasion arise. Including the infirm there are about 586 sick but no night nurses. When there are cases of grave illness or when death is imminent, someone is told off from the body of the house to tend the sufferer; but as this person is untrained, and is but one of the paupers who has undertaken the duty from kindness, or to obtain the extra food or slight privileges accorded to those who do such duties, the patient is at the best left but to chance and unskilled care. As in all such institutions the death-rate is rather over 3 a week, and many of these deaths, as is also usual, take place in the night, when the nurse is off duty; but we were informed that the nurses became so much interested in their cases, that they frequently forewent their well-earned rest to tend them to the end. This sacrifice should not be required of them. A good day nurse earns her night's sleep, and cannot forego it without a tendency to irritability on the following day, which acts injuriously on her patients. The lunatic wards are supplied with a night nurse, but the others depend on the sleeping deputy (an untrained pauper, hard worked through the day) who has first to be aroused, and then sent across the yard to fetch the sleeping day nurse; this obviously is undesirable.
Of the sick comforts the best is a good tray, invented by the present master. Mr. Dodge, in which, by the aid of hot water, the food is kept both warm and moist. There are no bed-rests nor self-lifters, and the beds being flock, are in our opinion, not those which conduce either to the cleanliness or the comfort of the sick, though no doubt suitable for the infirm, lunatic, and imbecile. The number of confinement cases is also large — 5O to 60 per annum. The women are delivered by the certified midwife, the doctor being paid 10s. 6d. per case; here, again, there is no night nurse. The children's ward, containing 18 beds, is nursed during the day by a capable nurse, who has besides five wards — including the lock — under her care, in all about 36 patients, but is left untended at night.
Of the pavilion wards in which the men are housed we heard complaints, as being hot in summer and cold in winter. Here, again, we found the nursing inadequate, and done entirely by men. The inmates are often of so rough and villainous a character that an excuse on that account has been made for the non-employment of women, hut of course the patients are of the same class as those filling the infirmaries and hospitals of our cities who are nursed by women. To obtain trained men-nurses is a difficulty, and we would recommend that the guardians should consider the advisability of classifying the sick inmates with some regard to their characters when possible, and supplying some of the wards with women nurses. While we are on the subject of classification, we would suggest that the plan of allowing the boys to mix with the men is a bad one. Boys come in with such disorders as itch, ringworm, early phthisis, or other diseases, which, while needing attention, do not compel the patient to remain in bed. To permit young lads to mix with elder patients, especially if, as we learnt, many of them are of more than questionable character, is likely to result in moral harm, which will ultimately affect the rates.
With regard to the insane, here again in the women's ward we found the brightness that is made by flowers and decorations, influences which affect for cheerfulness the poor imbecile women that are its inmates. They are nursed by one nurse and two assistants and one night nurse — an inadequate staff to deal with 102 cases, some of them apt to be fidgety, interfering, and occasionally violent, and all liable to excitement should a disturbance arise. We recommend that the staff should here be increased certainly by two — an extra day and night nurse and no pauper deputy allowed.
On the men's side there are but 70 patients, and for them the same number of nurses is provided as for the 102 women, but here again we. should consider the staff to be below the requirements. The place is well cared for, and books and periodicals are plentiful. The violent cases are sent to the asylum, but the authorities there object to receive general paralytic persons who at night are apt to cause difficulty.
On general matters we find cause for satisfaction. The laundry is worked by steam; the drinking and cooking water supplied by the company and periodically analysed; the fumigating apparatus is in good working order; the kitchen small, but good, and worked on the principles most generally approved, but not on those which the army has recently adopted, by which the food is Warrenised and 30 per cent. saved in cost, because all the nutritive qualities are preserved from waste. The waterclosets are sufficient and well flushed; the drains recently overhauled and ventilated; the infectious wards modern, suitable and well nursed.
We should advise that night nurses be provided for the sick and infirm wards, and that at least one probationer should be in attendance on each night nurse during her hours of duty. That the old, infirm, and paralysed men should be tended by women nurses. That additional nurses be engaged for the lunatic wards in order to insure none but professional attention to the sick, paupers being only allowed to do the scrubbing, etc. That the men employed as nurses should have some training other than that learned by experience through the patients. That the boys be divided from the men. That better bath accommodation be provided in the pavilion wards. That the nursing staff should be under a head nurse, who should take the instructions direct from the doctor. That bed cards should be more extensively used. That the flock beds should be changed to wire and hair mattresses for the sick, and that the guardians should consider the Warren method of cooking.
Since our Commissioner's visit we are pleased to learn from the newspapers that the Barton Regis guardians have decided to spend £200 a year on the "more efficient nursing of their sick poor," which action the Bristol Times and Mirror of September 29th, states to be "largely due to the increased number of lady guardians and the efforts of the British Medical Journal."
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