NUR 6130 Module 4 Public Health Nursing History Paper: Lillian Wald, Visiting Nurses and the 1918 Influenza Example

Climbing Tenement Stairs: Lillian Wald, Visiting Nurses and the 1918 Influenza

Student Name

M.S. in Nursing, Thomas Edison State University

NUR-6130: History of American Nursing

Mentor Name

Month Day, Year

Climbing Tenement Stairs: Lillian Wald, Visiting Nurses and the 1918 Influenza

Introduction

My first job after licensure was as a visiting nurse in Camden, climbing apartment stairs with a bag and a blood pressure cuff. I did not know then that I was working in a tradition more than a century old. This paper follows that tradition from Lillian Wald's settlement house on the Lower East Side, through the expansion of visiting nursing in the early twentieth century, to the 1918 influenza pandemic, and asks what it offers nurses working in communities now.

Henry Street

Buhler-Wilkerson (1993) describes how Lillian Wald, a graduate of the New York Hospital training school, was giving lessons in caring for the sick at home to immigrant women in 1893 when a child led her to a sick mother in a crowded tenement. Shaken by what she saw, Wald and her classmate Mary Brewster moved into the neighborhood to provide nursing care in people's homes. Their small Nurses' Settlement grew into the Henry Street Settlement. Wald's nurses could be called by families directly, not only by physicians, and patients paid what they could. Wald is credited with the phrase public health nurse, meaning a nurse who tended illness and also tackled the social and economic conditions that made people sick.

Expanding the Work

Buhler-Wilkerson shows how Wald turned a neighborhood service into a national model. In 1902 she persuaded New York City to place a nurse in public schools, where children excluded for minor conditions could be treated and kept in class; the trial was soon expanded across the city. In 1909 she persuaded an insurer, Metropolitan Life, to offer nursing visits to its industrial policyholders, a partnership that spread to cities across the country and gave visiting nursing a steady source of income. In 1912 she helped found the National Organization for Public Health Nursing and served as its first president. Throughout, Wald argued that nursing in the home could prevent illness as well as treat it.

Home Care and Its Financing

Buhler-Wilkerson (2001) places Henry Street in a longer history of nursing care in American homes, beginning with charitable societies in the early nineteenth century and the visiting nurse associations founded in many cities in the 1880s. A recurring problem was money. Visiting nurse agencies depended on philanthropy, on fees from families who could pay and on contracts such as the one with Metropolitan Life, which ended in the early 1950s. Agencies also struggled to balance care of the sick, which paid, with teaching and prevention, which did not. When Medicare began paying for home care in 1965, it defined the service mainly as skilled care after a hospital stay, a narrower vision than Wald's.

A Visiting Nurse's Day

The work itself was demanding. A visiting nurse might see eight or ten families a day, carrying a bag whose contents and handling followed strict rules to prevent the spread of infection from home to home. She bathed patients, changed dressings and cared for women after childbirth, and she taught: how to prepare a baby's milk safely, how to air a room, how to care for a family member with tuberculosis without infecting the children. Detailed records of each visit were kept for the agency, and these records are now some of the richest sources historians have.

Who Was Served

The visiting nurse movement did not reach everyone equally. In many cities Black families were served by separate agencies or not at all, and Black nurses were hired in small numbers to work only with Black patients. In New York, Jessie Sleet Scales began visiting Black families with tuberculosis for a charity organization in 1900, and Henry Street later added Black nurses to serve the San Juan Hill neighborhood. These efforts show both the reach of the public health ideal and the segregation within which it operated.

The 1918 Influenza

Keeling (2010) examines how American nurses responded when pandemic influenza struck in the fall of 1918. Many nurses were serving with the military overseas, and civilian communities faced an acute shortage just as demand peaked. With no vaccine or antiviral treatment, nursing care, including rest, fluids, nourishment, warmth and close observation, was the main therapy available. Public health and visiting nurses organized home visits, staffed emergency hospitals and trained and supervised volunteers, often working alongside the Red Cross. Keeling shows that nurses frequently made independent decisions in the emergency and that many became ill themselves.

Echoes in Recent Emergencies

Reading Keeling after working through the COVID-19 pandemic, I was struck by the parallels: shortages, volunteers trained quickly, nurses working beyond usual boundaries and nurses falling ill. Public health nurses again ran testing and vaccination sites and made home visits to people who could not travel.

What the Tradition Offers Today

Wald's model joined clinical care with attention to housing, work and schooling, ideas that public health now discusses as social determinants of health. Her partnership with an insurer anticipated today's debates about who should pay for prevention. The history suggests that community nursing thrives when nurses can respond to what families need, not only to what a payment rule covers.

Limits

This paper focuses on New York and on national organizations; rural and Southern public health nursing, including the work of Black public health nurses, followed different paths. It relies on secondary sources. The narrator is invented.

Conclusion

Buhler-Wilkerson shows how Lillian Wald joined bedside care with work on housing, poverty and schooling and how home care has always struggled with financing, and Keeling shows that nurses carried much of the response to the 1918 influenza when nursing care was the main treatment available. The visiting nurse tradition reminds community nurses today that the home and neighborhood are part of the patient's health.

References

Buhler-Wilkerson, K. (1993). Bringing care to the people: Lillian Wald's legacy to public health nursing. American Journal of Public Health, 83(12), 1778-1786. https://doi.org/10.2105/AJPH.83.12.1778

Buhler-Wilkerson, K. (2001). No place like home: A history of nursing and home care in the United States. Johns Hopkins University Press.

Keeling, A. W. (2010). "Alert to the necessities of the emergency": U.S. nursing during the 1918 influenza pandemic. Public Health Reports, 125(Suppl. 3), 105-112. https://doi.org/10.1177/00333549101250S313