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“Your attitude toward your work and to the patients in the Clinic is the utmost importance. It is a frequent fault on the part of the student to fail to comprehend that these patients are really ill. You should remember constantly that you are dealing with types of disease so serious and so numerous as to fill more hospital beds than are required for any other kind.
No matter how pleasant or normal seeming, how unreasonable and contrary a patient is, you must not forget that he is really sick; otherwise he would not be here.
There is nothing uncanny or disgraceful about mental disease, nor are all kinds incurable, as is often supposed. Your approach to these patients should be the same as to those of any other group.”
So begins the 1916 Psychiatry Nursing Procedures Manual for the Phipps Clinic under the leadership of its first director of nursing, Effie Taylor. Although Taylor, in her work at the Phipps, began to define the specialty of psychiatry nursing, its beginning was harrowing -- for the nurses at least. A year after that auspicious opening day in 1913, Taylor recalled the first days in the Phipps:
"The clinic was opened for patients in May 1, 1913, when one patient was admitted.
We felt very rich that night, for we had in the hospital eight head nurses, with only one ward open and one lone patient; but our grandiose ideas were short-lived, the next night a feeling almost of despair possessed us. New patients were admitted all day, and one ward after another was opened; by night we had nine patients on four different wards -- the private male and female wards and one male and one female public ward.
And this at once engulfed our eight head nurses, four on day and four on night duty, with no pupils to assist. Nine patients may not count for much, but let me remind you that there are patients and patients. Not since that day have we admitted eight such ill patients in a week—and this was in one day.
Then, to add to our distress, the workmen were everywhere in the building. The windows would not stay open, necessitating the change of every pane of glass. The continuous bath tubs would not work. The gas stoves leaked and could not be used. The refrigerating plant was not doing its duty, and we had no drinking water.
One of the patients was so destructive that almost every time rounds were made some new disfigurement of his room was reported, and over time we were indeed sad.
We continued admitting, and by June 1 we had forty patients.”
Eventually, of course, staffing was ramped up and routines developed. In an era before most psychiatric medications, nurses were involved in most aspects of care: from admitting patients and accompanying them to recreation and therapeutic activities to keeping them safe by locking doors and securing dangerous objects, to changing linens and supervising maids. They administered the treatments common for the day: continuous baths and cold packs for sedation and tube feeding for patients who refused to eat.
|1915 Facts and Figures|
|Beds||88 on 4 wards|
|Attendants - women||18|
|Compensation for nurses||$40 - $100 per month plus living expenses|
Nurses lived on the premises and their room and board was provided along with their salary. They generally worked eight hours a day and six hours on Sundays and earned one month of vacation per year. Graduate Head Nurses were entitled to an additional one-half day off each week.
At a time when hospital wards were usually staffed by students, the Phipps Clinic employed graduate nurses, those who had already completed their training. The use of such “regular-duty nurses” did not catch on elsewhere in the country until the 1930’s. Student nurses were part of the team but in an observational and learning capacity. The students attended lectures on mental illness and were also required to learn basket weaving, sewing, and the like. In addition to the graduate nurses and students, the treatment team included
social service workers, occupational teachers, physical instructors, and women attendants and orderlies.
The clinic was divided into four wards. The most acute were housed on the first floor and then they moved up to the second and third floors as they improved. Men were separated from women (creating eight units) and there was a separate unit for private patients. All patients were allowed to mingle during activities (as their conditions allowed) which staff believed gave them encouragement to improve.
The Phipps Clinic operated in the original building until 1982 when the brain sciences, psychiatry and neurology were brought together in the newly completed Adolf Meyer Building nearby. While a great deal has changed in the understanding and treatment of mental illness over the last 100 years and today’s psychiatric nurses need to be skilled in many new areas, the constant of care, compassion, and attention to the needs of the whole patient have roots that go back a hundred years.