The more things change, the more they stay the same.
PLANS FOR PUBLIC HEALTH NURSING SERVICE IN WYOMING
Approved by the State Board of Health–November, 1936.
- DEFINITION OF PUBLIC HEALTH NURSING.
A public health nurse is a graduate nurse specially trained in the field of public health nursing, working under the supervision of the Federal, State, and local health organization.
The services rendered come under two headings: 1. Nursing Care. 2. Health Education. In general, it may be said that it would be a rare occasion if, when the public health nurse gives nursing care, she does not give education in the field of prevention of the condition which she meets, either verbally or by demonstration.
- GENERAL POLICIES
- It may be said that in the course of the work a nurse will be expected to take advantage of every opportunity to give instruction regarding the procedures tor the care of the sick, the prevention of diseases with emphasis on the rules for the maintenance of health. Where she finds evidence of existing defects or of illness, she should use her influence to secure speedy medical or dental care. She should always be most careful neither to diagnose nor to recommend treatment of any kind; nor should she ever suggest a particular physician, even though the patient has no regular one and asks her advice.
- If the nurse comes in contact with a sick person who is under the care of a private physician for the illness in question, she must give no care whatsoever until she has communicated with him to secure his orders. It is under stood that in an emergency situation, the nurse at any time will act according to the needs of the situation. An emergent situation should be distinguished from a non-emergent illness by keeping in mind the definition of an emergency, namely: “First aid is the immediate, temporary treatment given in case of accident or sudden illness before the services of a physician can be secured.”
- If a person asks the nurse for advice as to the selection of a physician, she should refer the patient to a list of physicians in the community. She must be meticulous in not giving the patient any clue to her own personal choice of a physician. Should the patient be insistent regarding advice on the subject, as occasionally happens, the nurse should refer the person to the list of physicians in the community.
- Verbal orders given by a physician in case of an emergency should be followed by a signed order of the physician.
- STANDING ORDERS.
- For most of the conditions met by the public health nurse where treatment may be given on first visit, the standing orders are given below.
- The nurse may instruct the family in the hygiene of the sick room but must explain that further care depends upon the attendance of a physician and upon his orders.
- All new patients should have pulse, temperature, and respiration recorded and be given nursing care as suggested below.
EMERGENCIES AND ACCIDENTS
Nursing Care: This should be well covered by the first aid training of a public health nurse and executed accordingly. Only first aid should be given and immediate contact should be made with the attending or family physician or headquarters. In the event of a severe accident the nearest physician or hospital should be called, and the attending or family physician be notified of the disposal of the case. Subsequent nursing care should be carried out or the instructions of a physician or public health official.
Health Education: Little can be done on the first visit. Accident prevention can be emphasized later.
Nursing Care: Put patient to bed. Give tepid sponge bath if patient is restless or markedly uncomfortable. Liquid diet.
Health Education: None at this time.
(with or without diarrhea or constipation)
Nursing Care: Put patient to bed. Give nothing by mouth other than sips of water. Give no medicine, cathartics or enema until ordered by physician. Make immediate contact with physician or local relief agencies, especially if fever is present.
Health Education: Emphasis of above.
Nursing Care: If fever is present, put patient to bed and notify physician. If no fever, advise patient regarding the infectious nature of a cold and use usual methods for isolation and disposal of secretions as prescribed by local or state health authorities.
Health Education: Instruction regarding the infectious nature and disposal of secretions and the importance of sequollae.
Nursing Care: If communicable disease is suspected so inform family. Isolate the patient. Report immediately to county health officer. If the family can not afford the services of a physician the nurse should notify the proper authorities.
Health Education: Emphasis on the necessity of above.
Nursing Care: Usual bedside care with special care to secretions and excretions.
Health Education: Patients suffering from tuberculosis should always be under the care of a physician, but they often report to him at long intervals. The nurse will be guided by the physicians advice regarding sanatorium care. Where there is no private physician, the clinic or health officer should be consulted. In the absence of special orders, the nurse should give periodic supervision, giving advice regarding accepted standards of hygiene for tuberculosis patients stressing rest, diet, fresh air, care of sputum, and the protection for the contacts: including regular physical examination particularly for children.
EAR ACHE OR DISCHARJING EARS
Nursing Care: None ether than to seek medical supervision.
Health Education: Instruction regarding disposal of secretions and importance of medical care.
INFLAMMATORY CONDITION OF EYES OR EYELIDS
Nursing Care: None other than to isolate and seek medical care at once.
Health Education: Instruct regarding possibility of dangerous consequences, if specific, connected with inflammation of eyes or eyelids and of possibility of its infectiousness.
SURFACE INRJURIES OR INFECTIONS
Nursing Care: Dressings for minor injuries or surface infections. Cleanse with soap and water and apply tincture merthiolate or iodine if the injury is fresh. Cover injury or infection with a loose sterile dressing and secure medical attention.
Health Education: Instruction regarding possibilities of any superficial or deep wound or infection.
Nursing Care: Remove clothing over burn if not adhered to skin; if adherent, cut clothing away. If burn is of first degree, apply sodium bicarbonate solution, expose to air, and seek medical advice. If burn is of second or third degree, use only sterile dressings and seek immediate medical care.
Nursing Care: Little is required other than routine nursing care. The importance of this visit is:
Health Education: When contacting expectant mothers the nurse should first find out the name of the attending physician and seek his instructions. If the expectant mother is not under the care of a physician the nurse should emphasize the importance of medical supervision. Routine instruction in personal hygiene, including habits of living, importance of fresh air, sleep, rest, exercise, baths, dress, diet, and recreation are important. In. follow-up calls, it is advisable to take pulse and temperature readings. Special advice regarding the care of the nipples should be given after the sixth month of pregnancy. Advice regarding layettes and other supplies may be given. A report of each prenatal visit should be sent to physician in charge of case, and any adverse symptoms should be reported to him immediately.
POST PARTUM AND NEW BORN CARE
If the physician is in attendance, get orders from him. If no physician is in attendance proceed as follows:
Nursing Care: Post partum hemorrhage. In the event of post partum hemorrhage
- Attempt to hold the fundus of uterus firmly between the thumb and fingers of the hand.
- Send immediately for family physician and if unable to reach him, call nearest physician.
- Elevate foot of bed.
- Apply ice pack to abdomen.
Post Partum care: Record temperature, pulse and respiration; give cleansing bath call physician.
New Born Care: Record temperature, pulse and respiration.
Inflamed eyes: Notify physician or responsible authority at once.
Bleeding from cord: Tie tightly and securely with sterile tape; apply sterile dressing and firm binder; notify physician.
Excoriated Buttocks: Cleanse with oil. Instruct mother regarding care of child and diaper. Notify physician.
Convulsions: Sand for physician at once. Undress child moving him as little as possible. Give warm (105 degrees F) mustard bath (1 teaspoonful of mustard dissolved in a little tepid water to 1 gallon of water) If no tub is available, give hot pack. Keep cold compress to head, following bath or pack, place patient between warm blankets and maintain absolute rest.
Health Education: Instructions regarding above naturally follow the nursing care.
Activities which may be undertaken depending on local needs:
- Teaching of first aid, home nursing and child care.
- Prenatal nursing supervision and mother’s classes.
- Teaching and demonstration of the prevention and control of communicable diseases including tuberculosis, syphilis, and gonorrhea.
- Supervision of the infant and preschool child through home visits and group conferences.
- Supervision of the health end habits of the school child including assistance in the control of communicable disease, and the correction of physical defects in cooperation with the physician, school personnel and parents.
- Other activities may be arranged if desired by the local physician and approved by the State Board of Health.
To aid in lowering maternal and infant mortality, it is proposed to place one nurse in a portion of a poor rural community, probably either in Platte or Goshen counties, to give prenatal nursing supervision and to conduct mother’s classes. This will not include nursing service at delivery.
- To contact all mothers as early in pregnancy as possible.
- To advise that they are provided with both medical and nursing service throughout the whole period of pregnancy.
- To instruct mothers and fathers in maternal hygiene and infant care, with the consent of physician.
- To instruct and aid in the preparation for delivery with the consent of the physic1an.
- Cooperation in each individual case with the physician in attendance in whatever way he may request. The amount of instruction and the number of visits to the home shall depend entirely on the wishes of the attending physician.
- Conferences or classes with prospective mothers to emphasize the importance of medical care.
- Home visits for individual instruction and demonstration according to the wishes of the physician.
- Classes in:
- Prenatal core
- Clothes for the pregnant women
- Proper diet for expectant mother
- Babies clothes
- Supplies for the baby
- Demonstration of the baby’s bath
- Preparation for home delivery
- After care of mother and baby
Any expectant mother under the cure of a private physician must obtain his consent in writing before attending these classes.