DN150: One Hundred & Fifty Years of District Nursing

district nursing 150 - queens nursing institute

zena edmund-charles

Zena Edmund-Charles MBE (nee Josephs)

 

Zena was born in Jamaica in 1932, the youngest of ten children.

She writes, “My father decided nursing was not for me. He suggested I go into teaching or dress making. Why?…since the age of 5 years I knew I wanted to be a nurse. 

She trained as a midwife in Kingston, Jamaica and practiced as a community midwife there before coming to England in 1956 to pursue her career. She did her general training at Bethnal Green hospital. In 1959 she moved to Queen Mary’s Hospital in Stratford, East London to do her Part 1 Midwifery. She writes:

“I enjoyed my working days in hospital. Many of the student nurses and even some staff nurses could not cope with the strict discipline on and off the wards and for this reason would give up their training or travel back to their home land. I had no problem with discipline, and came into this with one thing in mind, come what may, and that was to pursue a career in nursing.  My parents were very strict, so my up bringing was a strict one.  Discipline, honesty, time and respect were never allowed to be forgotten not even for one minute.

“Through the years I had several favourite patients with men and women.  Some of these patients would refuse to be treated by other nurses because they were heavy handed, but I put myself in their position and treated them as I would want to be treated.

“As students we were taken on day trips to places such as Oxo, Glaxo and the sewage works. I loved the day out, the teas, the little gifts - but not parts of the sewage works! 

“All ranks of nursing staff had to be properly dressed at all times when on duty.  Well pressed striped blue and white dresses, shining white and well starched aprons and caps, black stockings, black lace up shoes with rubber heels.  Hair had to be up off the shoulders and collars, nails clipped short and clean, no jewellery, no wrist watches, starched belts - colour according to the year the student was in.  Each grade had its own colour belt.  Matron wore green and the sisters were all in blue dresses with long sleeves, and would wear a white frilled, elastic cuffs when they rolled their sleeves up to perform a duty in nursing.  If the cap was not folded in a way that it looked like the bakers’ hat, you would be asked to remove it from your head and then the sister would re-fold it.  Nurses had to report on and off duty also to the dining room at meal times on the dot of time. Late? Never.

“If you should report being sick, the Nurses Home Sister would check your temperature and if there was no temperature, off to the ward you go. You would not be considered to be as being ill. Some of the girls knew how to beat the sister however, when she was due to visit them these girls would put hot water, tea or food in their mouth, hence the reading of the thermometer would show a high temperature - they were never found out.

“All nurses had to be in by 9.30pm. The porter would lock the gates at this time.  If one wanted to come in later than 9.30pm then she would have to ask the matron for a late night pass which allowed one to come in through the gates no later than 10.30pm. The Irish girls had to go dancing every night at the Lyceum and 10.30pm was too early for bed, so they got friendly with the gate porter who would let them in whenever until the night sister caught up with them coming in later than permitted. They were reprimanded by the matron and no more late passes given. So what did these girls do? They managed to cut a hole large enough in the wire fence behind the nurses home and from thence they had a whale of a time going in and out as they pleased.

“Every one had to have a handle on their can (an old West Indian saying). All had to be addressed correctly: Mr, Mrs, Miss, Ms, Sister, Staff Nurse or nurse. Very rarely the night sister would be heard calling a very ill patient by his or her Christian name. The consultants are Mr or Mrs. Junior nurses did not have much to do with the Registrar or consultants. The clerical, domestic and porters all had to be addressed properly…that’s good old fashioned respect.

“In the dining room the staff had their tables mapped out accordingly - Sisters, Staff Nurses, 1st, 2nd and 3rd year.  The dining room Sister was a lovely middle aged Scottish lady. Very gentle and kind, she always tried to help, but was firm and strict. We had 2ozs butter weekly each. The order of the day was margarine and beef dripping from the kitchen. Some jam and marmalade was allowed. The food was good.

“Forty four hours per week were worked.  I had 1 day off weekly and two weeks’ holiday per year.  Each nurse spent 3 months in each of the 3 years training on night duty. Wages were £10 per month for 1st year staff in the 1950's.

“Gifts to nurses from the patient or a family member had to be sanctioned by the ward sister. Gifts of money were rarely accepted and if they were, then it would be put away and shared among the staff in chocolates or stockings at the end of the year (Christmas). Once a favourite male patient of mine left me his portable television on his death, but I was not allowed to take it – Oh, how I was disappointed, I had to donate the set to the ward. Very few wards had televisions in those days so it was well used and many had the benefit of it and not just me, on my own.

“At night the television had to be switched off by 9.30 - 9.45pm. Well, that’s one rule I never did obey (naughty and mischievous girl). The patients (all men) and myself needed to see the sport, football, boxing and wrestling, especially. I shifted the bed of a patient who was able to nip in and out of bed next to the communicating window ledge on which the television was and when the matron or night sister was heard or seen coming on her round, the television was be switched off and all the patients fast asleep - some would ever be heard snoring. Then no sooner had she gone than they are all awake and on goes the television until they all are ready to go off to sleep - then I would switch it off and put its cover on for the night.

“Nursing and caring for the patient and their families was a serious business. No messing around or cheap talks and laughter around those being cared for were permitted. That did not say we could not have a quick chatter and laugh with patients providing no one was awaiting any attention. We were little devils when the cat was away and there was much good clean fun with the patients who were up to it. They were devilish themselves and on sisters return they, like us, were perfect angels, butter would not melt in their mouths.

“No one was allowed to sit on the beds, not even the patients could sit or lie on top, they had to sit on the chair or be in bed properly. No dirty utensils could be seen hanging about on the bed, lockers or tables. Tablets, or any form of medication, was not allowed to be left on the bed side table if the patient was asleep or out of the ward e.g. at X Ray or physiotherapy.   Pillows all had to be neat and tidy, with the mouth of the pillow cases turned away from the door, especially before the visitors came or ward rounds.

“The student nurses did much of the cleaning and dusting. Polishing the floor was done by using a heavy bumper by using a swinging movement - it was heavy - no hover!  The ward sister and Matron would run their fingers along the window sills and ledges in search of dust and dirt. If any was found there would be hell to pay!

“Although the coal fires were always burning there was never any dust or dirt to be seen. The nurses even had to clean the windows in the sterilizing room. I never did see window cleaning in my nursing role, but I did it as I was told. On weekends and Bank Holidays the student nurses spent much time in cleaning the wheels of the bed. All fluff had to be removed using tweezers. The bed tables and lockers had to be scrubbed in and out.

“There was a four hourly bed pan and bottle round were on every ward to every bed fast patient. No bed pan was allowed during visiting.  If you did not use one before the visitors came in, then you would have to wait until they were all gone and the ward closed.  If a bottle or bed pan was seen on the bed, locker, floor or chair the nurse responsible would be slated by the sister.

“Some of the patients in the general hospital, especially those on the medical and grannies’ wards, were very prejudiced towards the black nurses.  Some of these were even retired teachers yet they did not know better.   I can remember being asked …why did I have to come here to do nursing? I said, because we do not have nurses and doctors and when someone gets ill, we have to wait for medical and nursing help from England.  (I now think I was very mean with my reply).

“At visiting times the patients who did not have visitors had to the made to feel wanted. The student nurses would sit with the patient and talk to them until all the visitors went. Our patients in those days did not have and depend on volunteers to wash, feed or visit them. The nurses had that in their daily duties. That is what we called nursing. 

“Our concern was not only to the patients but also with their loved ones, their families.  Our patients were also number one in our lives, whether they were racist, uncouth or not.  They had to be treated with respect and their dignity would not be taken from them. There were no mixed wards. Ladies were in their wards and men in theirs...

Community Midwifery

“After my midwifery training I started to work in the community as a midwife and also in the teaching of student midwives.  My training was six months full time in maternity in the East End of London and 6 months within another hospital and the community. Community midwifery was most rewarding in my time of working as a midwife

“Expectant mothers who wished to have their babies delivered at home by the community midwife were able to do so. Some babies were the first baby. Antenatal care was given by the doctor and midwife of the practice.  The midwife applied the same care as that in the hospital.  Scrubbed hands using water, soap and nail brush. Clean aprons had to be worn for each delivery, also face masks, gloves (sterilised for the delivery), sterile dressing packs and instruments were used. 

“After the delivery of baby mother would be asked to spend at least 6 days in bed, but very often after the midwife had left, the mother would hop out of bed to do whatever and then return to bed when she thought the return visit would be made.  She would report having a well earned sleep after being left alone, but seeing the soles of her dirty feet proved that she had been for walkies! She was clever enough to get out of bed but not enough to wash or wipe her feet. 

“The midwives were conscientious and practised good nursing and respect all around. The first thing we had to remember was that we were guests in the patient’s home and should behave as such.  The rules of cleanliness were always there. Occasionally, there would be a forty-eight hour discharge of the mother from hospital following the delivery of baby, into the care of the midwife. When the baby was discharged on the tenth day after birth he or she would be cared for by the health visitor. If baby was not fit for discharge or if the umbilical cord had not fallen off or healed, the midwife would continue the care until all was well.  If for any reason mum had a temperature the midwife might request the district nurse’s help so as to prevent any cross infection to other mothers.  All expectant mothers knew their midwife and how to get in touch with her if at any time she needed to. The mothers were never left with an unanswered question.

“There was no central heating in these houses, no running hot water, and the toilet was outside. Some homes had one bedroom with a family of 2 or 3.  Some had no electricity. Light was by a little gas mantle on the wall.  Heating was by coal fires and some had no bathroom. These people were very grateful and had no time to be rude, to mourn nor to complain, it was a pleasure visiting such homes.  Always a cup of tea and a smile, although a cup of tea was not always a good thing because the kitchen sink took the strain for everything!  


District Nursing

“After some ten years of community midwifery, I moved over to district nursing, and in these early years we were in the Essex Health Authority.

“Each of us was issued with a tin case in a blue canvas bag with the following items: a good hand towel, a small cigarette tin with a piece of soap and a pill vial with dettol, a pair of rubber gloves, a nailbrush, one thermometer, a pair of surgical scissors (small), a pair of artery forceps, a syringe and needle, a few squares of gauze, and a hand full of cotton wool balls, a small vial with surgical spirit, a small sinus forceps, non toothed dissecting forceps, and a small packet of sterilised dressings. Hands had to be washed properly before and after treating each patient.  All dressing had to be done with the non touch technique. An apron had to be worn whilst attending the patient.

“In those days sterilised dressings were not supplied by the hospital, therefore cotton wool balls, gauze rolls and gamgee roll were supplied by prescription from the GP. So how did we manage to have sterile dressings?  Well - we had to find a fair size empty biscuit tin, wash it properly, dry it well, and place a mixture of cotton wool balls, gauze squares and various size cut pieces of gamgee in it, then ask the neighbour to bake the contents in their oven if the patient was unable to do it for herself.  At each patient’s home before and after each treatment the gloves and any instruments used had to be washed and boiled in a saucepan before being placed in the nursing bag or used on another patient.

“When the weather was cold, nurses would spend time to rake and light the fire, also make the breakfast - maybe of toast, cereal and a cup of tea. The room would be too cold to give a blanket bath therefore the wash would be cancelled for the day. On some Sundays and Bank Holidays I would cook and take a hot meal for my patient and at Christmas if I did not take a meal then I would arrange with one of the churches to take a dinner home for the lonely person. 

“The patients never complained, though there were a few who were very prejudiced against black nurses. After each visit to the patient, on returning to base, our nursing bags had to be cleaned, the instruments sterilised by boiling, gloves washed and powdered, dettol, soap and a clean hand towel all put into the nursing bag ready for the next visit.

“The Lady Rayleigh Nurses Home in Leytonstone was my base, and it was like a mini hospital.  During the day the midwife would hold clinics for their patients and in the evenings the district nurses would have a clinic for the working patients, others working in the nearby factories would come in at any time an accident should occur and they would be seen with no question asked. No one was ever turned away, nor had to wait to be seen. Whoever was in the building at the time, be it the tutor, superintendent, or midwifery tutor, they would roll their sleeves up and attend the wounded person. 

“In the early days there were only two car drivers amongst the nurses, although many were licensed drivers. A couple of the nurses owned a moped, while we were issued with bicycles.  As one of the cyclists I enjoyed my nursing and my bicycle. There were less motor cars on the roads and the drivers then all had licences and insurance and were proper drivers. It was pretty safe on the roads, unlike today.  Nurses were respected and would not be molested or mugged. The patients, their families and neighbours all respected the nurses. 

“The patients would be visited daily, twice daily, alternate days, twice weekly, weekly, monthly, six monthly and three monthly. Visits varied according to the patients needs. Types of care given included daily washing, morning and evening wash and put to bed, administering insulin am and pm, changing dressing to wounds, attend to glass eyes, administering iron injections, gave blanket baths, visit to observe patient management and bereavement visits, and giving enemas.  There were a few patients having a ring pessary change. Nurses very rarely worked in pairs even when the patient being visited was very heavy and bedridden. 

“Whatever the treatment requested, it would be carried out with a high standard, even feet washing was taken seriously.  No treatment was considered above or below the nursing sister.  Nurses were trained to respect and care for every aspect of advice, care, prevention, discussion, and teaching.  We had to be sympathetic, show understanding and most of all always be ready to listen to what the patient was saying.  It does not help to tell the person suffering that you know what they are feeling. You do not know. How can one know what the other person is feeling?  All nurses had to bear in mind the fact that we were guests in the home being visited to perform a specialised task. We were taught that the patients were always number one. 

“The majority of the patients were elderly and house bound, people living on their own in a three bedroom house. The toilets were outside, there was no running hot water, with open coal fires which were the in thing in those days. Some of these poor old dears had no families, and if they did they could be living abroad or miles away. Neighbours who were also elderly played a great part in their lonely lives by visiting and making a cup of tea. The neighbour would have a key to the door, the nurse might have one at base or one would be left dangling on a piece of string by the letter box - in those days it was pretty safe to leave a door key hanging on a string, over the door ledge, under the door mat or underneath the plant pot.

“Although the monthly wage was £10 and the hours worked weekly were 48 and very hard, I thank God I did my training in those days, because all to do with nursing was perfect, and everyone concerned was interested in 100% proper care and attention for whoever was in need of help. There was love and dedication from all, or most of us, who entered the field of caring, be it medical or nursing. I am proud to be a part of those days.”

Zena was awarded the MBE in 1996 for services to community nursing.

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