HOSPITALS REPORT.

Dominion, Volume 3, Issue 638, 15 October 1909, Page 3

HOSPITALS REPORT.

RACY REMARKS>ON MANAGEMENT. WORK OF DISTRICT NURSES. ■'•;•- The anniinl report on : lM»pitals', and'charitable nid, which was Submitted to the House of Representatives yesterday, states that the expenditure! on hospitals last year, was J!23<3,803, nn increase'of £26,023 v as compared, with the previous year, and the expenditure' on charitable nid .£112,818, an increase of £BlGi, making a total increase of .£34,425. The receipts amounted- to .£2<;6,402. ■ There is an increase of JC4982 'in voluntary, contributions. The in-j crease of ■.£595 in patients' payments is in proportion to the admissions, which were l!t,G!>3, as ngninst 19,160 of last year. An improvement in this source of revenue may reasonably bo looked for, especially as..there is nn increasing tendency on the part of persons who are able to pay to lake advantage of the public hospitals. At present payments by patients barely'amount.to one-eighth of the total receipts. There is little or no uniformity on the part of hospital authorities, either as to the scale of mainteunnco. foes, which' vary from £\ to £2 25., or as to the measures taken to enforce payment. Uniformity, though.much* to l>e desired, is, however, difficult to bring about. The scale of fees, and tho measures taken for collecting them depend to a large extent upon- the general prosperity of t!io district in .which Ihs. hospital'is situated. But hospital authorities: might do much more as regards: collecting maintenance fees 'from patient* who are known to be'in a position to pay them. In a rapidly-developing country a decrease in capital ' expenditure can hardly , bo looked for. . For the most part, it is claimed, the, Dominion got fair -.value for ' tho money, but m eome instances- tho, workmanship, especially in plastering and general: finish, 1 , was very poor. ... ■• . ' ■ Tho increase of ~£3075 for provisions (.£42.485) does not-seem large;,but it' is one in which considerable saying can bV effected without in any way stinting tlie patients. Speaking-gene, rally, hospital authorities.buy their foodstuffs at reasonable rates, .but it is interesting •to note the varying 'prices, paid. For example, tho *lb. loaf at Taumanijim costs' Sid., at Oamaru «d whilst • at. Waimate, which is ony thirty-three miles therefrom,, and in"the■ centre of the wheat-growing district,' t!ie cost is <d. Milk .varies from Is: Cd: per gallon -at Taumarunni to 7d. per gallon at Ghristchurch; Butter- vanes from • Ud. < to Is. 2d. per-pound, ihe prices paid for.meat also vary considerably. '•■..-.. Hints on Management, • 5?S >e ° f , onr hospitals are well, and others indifferently, or, badly, managed (states Dr. \ alintme); but,, generally speaking, mismanagement is not due , to want of effort on the' part: of the controlling authorities. ■ On tho contrary, it is well-intentioned 'but misdirected effort that is responsible for so much. Nevertheless, mismanaged as some undoubtedly are.-it wouldbe a bad day for tho hospitals of the Dominion if anything were done that would be likely to minimise the extraordinary interest vouchsafed to them by the general public. Hospital .authorities might bear in mind the following points:— (1) When you have good officers, leave thorn alone: if you trust ; them, they will confide in you. . r ■■■■'. '•■■., ■..-.

'; (2) An ill-paid secretary' is . tho worst' form of hospital economy. ' .':.':■ (3) Only consider, complaints submitted in writing: deal with, them promptly. Never consider a. patient's complaint unless it is made within one-month of his leaving tho hospital. ■ ' ' :.' (i) See that the by-laws clearly' define the duties of the executive officers: you can thus sheet responsibility home. See that the bylaws are rigidly enforced. ■ ' (5) 'Well-kept books; particularly easo and operation books, have nipped in' the bud many .a> -promising hospital'scandal. ■' •'•<■. (6) Trust tho matron to watch,the,back door nnd the doctor ■ the front. More goes out by the back door than you think, and .less comes in._by that door than you reckon, or pay for. 1 (7) Justice is a blind goddess, so is a matron without, scales. . . . ' - ■

T°^tho"trustees of (very), small.separate in- ,' ' ■ .i . ■■«.-.■. (8) Do, not ask-the cook what she thinks of the matron: 'twero better far to ask the matron what she thinks of the cook. Speaking generally,' the professional work in our hospitals' is of a high , 'order.'and' the medical and nursing staff have thoroughly at heart the general interests ot.their.- institutions. If this- were better recognised, and the. above rules. observed,' we should not.. hear so many complaints'which from timo to time disturb the harmony of bur hospitals, and engender suspicions as to their management in tho minds of a sensitive public.

The District Nurse, ',■■..• One of/the disadvantages of the present hospital system is that its benefits are unequally distributed throughout the, various hospital districts. This, of course, is unavoidable. A hospital .system is wanted that can make itself felt throughout the length and breadth of the Dominion, and by means of a system of district nursing this object can in some measure be attained. It is proposed 1 that these nurses bo appointed by the hospital boards, b'noked'up by tho moral and' pecuniary support of the settlers. The boards and the public are in favour of the'scheme, but the former are inclined to hesitate on account'of the expense. We must therefore move carefully, and only ask boards ,to 'appoint district nurses in tho more remote country districts. But if the scheme is: well supported by the settlers, there should be no part of'a hospital djstrict without district nurse. . In no sense, of the. word would the district nurso be expeoted to pre-. scribe, use 'instruments,'' or in any way take the place of a general medical practitioner* The district nurse would be' the servant of the, 1 hospital board of tho district, and would bo recognised as.a very responsible officer of the. hospital staff. Her salary would be entirely paid by the board. She would hand in to tho board all- fees collected for. visits, etc., which would bo on a prescribed scale, and on her recommendation would tho board be guided as to the amount of such fees to bo charged,in each, individual case. Thoso, in. the .nurse's opinion, not in a. position- to pay fees would not be charged. . . ' ... . ■ District nurses wero required in any district far removed ■ from medical a?;istanco, and tho way to set about getting adistrict nurse was by applying to. the district board. • The good work of the St. Helen's Hospitals liad . cou> tinucd. ■••. ••■':■-•:■ i .••■'■' •.,■ '. ■ ( •' , . ' SOME NEEDED' REFORMS.' . ■;■■'. AN. INTERESTING REPORT. . .... ■ Of the many reforms needed in our charitableaid system, two. of the chief aro:—(a) Cooperation between public and private charitablo organisations and (b) the appointmont of trained ■ nurses ,as- matron-superintendents of our old people's homes (states Dr. Valintinq in the annual report on hospitals and charitablo aid). The remark's at the recent conference of charitable ■ organisations at Christchurch cltairly'febow the need, of some cooperation/between Sialic, and private organisation ta. prevent, the overlapping that now takes place in the-distribution of relief. The Department will do all that can be done to bring about co-operation' between charitable organisations. .During the past year Dr. .Valintinorhas ad.vised more tliau one board' to appoint l a trained nurse as- matron-superintendent of. an old people's home.' llariy, of tho inmates, from their very age, require' those little attentions that an'.'unskilled person can hardly, givo; arid when, as is often the case, they become acutely ill,..a'.trained nurse is all , the more indispensible. To those charitable institutions where, a chronic ward has been' attached' the' appointmont of a trained nurso should need no argument. '■■■■■■'-;■■. ■' ' ' .'

To the'uninitiated this may seem a, somewhat extraordinary proposal:" A woman to control these old men ?" But, nevcrtheloss*(continues Dr. Vnlintine), if thoe* critics could but visit the West Const hospitals, which for the most part are only old homes, they would bo surprised to. ece how easily the aged inmates are > managed by a good, tactful woman. There nro no resident medical officers at'these hospitals. The matron is in chargo, nnd ono seldom, if' ever, hears complaints as to the management, which is by no means the caso where the institutions are controlled by a mnster, and his wife as matron. The reason for thie, however, is not far to'seek. A nurse has bfen trained in the management of tho sick, which is of undoubted assistance to her in tho management of the comparatively healthy; whereas, the married couple Usually to bo found in chargo'of these institution's have had littlo or no training in the work, intrusted to them. Moreover, the attitude that the untrained master adopts to the inmates is rather that of. tho, policeman, which very often goads the inmates to defiance. But if by any chance a good master is obtained, docs it follow that his wife, will make'a good matron, or vico versaP"-. '.-'■ . ■ •'■.-■ ■ '_■■.■■ . ■ ■■ : . ■

A good deal has: been- done during the last two years. Trained nurses have been appointed to the chronic wards of. some of our larger. homes, and lately a woman with considerable experience in asylum -nursing has' been appointed in-sole cherge of a charitable institution, with apparently every satisfaction to the inmate and to the boards.