Archive | September 2012

1969 SENIOR YEAR TRAINING AT PROVIDENCE LYING-IN HOSPITAL

 

 

PROVIDENCE LYING-IN HOSPITAL

 

 

 

MY ROOM AT LYING-IN WITH MY SENIOR CAP

 

 

At the beginning of our senior year in Nursing, in the summer of 69, we start with our 3 month rotation at Providence Lying in Hospital for obstetrical and gynecological nurses training.

 

Providence Lying-In Hospital is a historic hospital building, located on 6 1/4 acres off Smith Street, in the Elmhurst section of Providence, situated at the end of a short access road, at 50 Maude Street, which leads directly into the grounds. The 1926 Collegiate Gothic style hospital is a four and a half story, red brick structure trimmed with Indiana limestone and capped by a slate, gable roof. Its most distinctive features are the six story central tower and a series of projecting bays combined with an overall fenestration pattern that provides a pleasing rhythm along the length of the building; allowing for a comfortable interior division of work space and patients’ accommodations while the numerous windows provide ample light and air circulation.

 

A course of limestone above the first floor level on all elevations is the single horizontal element of the original design and serves as a visual base for the bays and towers that extend upward. The central tower is turreted at each corner with a round cap drawn to a point. The point is extended upward by a wind vane whose decoration is a long, graceful stork in flight with a baby in a blanket suspended from its beak. The portion of the tower above the roof-line includes limestone reliefs of a winged cherub, an angel, and a mother and child. The tower has five bays at each floor. “Providence Lying-In Hospital is inscribed above the second story windows. The main entrance has limestone quoins on both sides and a flat Gothic arch. The door itself is a modern one of aluminum and glass. The window pattern of the main elevation is symmetrical above the second floor, bi-fold type that folds outward as the edges are drawn to the center. Each sash has ten panes. The Father’s waiting room has Gothic detailing and the main waiting area with wood paneling and a marble fireplace with a flat, Gothic arch.

 

The 1933 nurses’ residence is of similar materials, massive and style as the original hospital building with exception of the windows, which are six over six double hung sashes. The trim detail including the window and door quoins and course at the first story are cast stone rather than limestone. Dormers and pediment bays punctuate the slate roof-line in the manner of the original hospital building. There was an addition added in 1941, an auditorium and facilities for residents that faithfully continue the composition of the original construction.

 

The two buildings are joined by a two story hyphen, creating a broad “U” form surrounding a circular drive between the buildings. At the rear of the hospital is a two story, smooth faced concrete addition built in 1956. This infill structure joins two short wings extending from the old hospital building. The area surrounding the hospital is a landscape of mature deciduous trees, foundational plantings, and to the west is the large asphalt parking area bordered farther to the west by an undeveloped wooded parcel of land, with open spaces at the western perimeter of the property.

 

Incorporated in 1884 it is the first to provide on-going obstetrical services in RI and the first to offer specialized nurses’ training and on several occasions was recognized by leading national authorities on maternity care, who lauded it for its contribution to the development of the modern concept of a hospital devoted to healing and teaching- an attitude beyond the earlier notion of hospitals as institutions for the indigent. It pioneered the concept of caring for the emotional as well as the medical needs of its patients. Prior to its opening there was no place in the city where a woman, not living in her own home, could have in any measure proper care at confinement. Patients paid a stipulated price for the privileges afforded them by a well regulated hospital which was an attempt at removing the stigma around entering a hospital. The intent was to provide services for all classes of women, not only the poor, and it was supported by contributions.

 

In 1888 a training school for nurses was established offering generalized and specialized obstetrical training as well as post-graduate work and the first in RI to do so. In 1892 it established a department for the care of infants with specialized medical needs. The hospital is a manifestation of the social consciousness which was an outgrowth of the great industrial and economic expansion of the nineteenth century. It significant in the development of the modern concept of the hospital as an institution devoted to healing and caring for the sick and as a center for research and teaching.

 

Previously hospitals were built as “Rigs ward” which was copied extensively throughout the world and was a nightingale ward redesigned for more privacy. The ward plan named after Florence Nightingale provided efficient care of the patients by reducing the number of beds in a ward and locating the nurses’ station centrally within the ward. This structure was designed as a pavilion combining private rooms and a ward, greatly augmenting the proportion of private rooms. No ward was designed to hold more than six beds, this was indicative of the twentieth century trend towards greater privacy. Environment was seen as important including: the contour of the land, the surrounding country, the accessibility for friends to easily get to and from the city by roads and trolley, expressing cheerfulness, inspiring confidence, courage and dignity.

The above information is from The National Registry of Historic Places.

 

No matter where we are training our curiosity gets the better of us and we investigate our surrounds. We find a built in cabinet and open the large wooden doors and find ourselves looking at many shelves full of 5 gallon glass jars filled with fetuses and dead babies, many grotesque forms all in a row from the ceiling to the floor. We stand frozen in our places, not knowing what to make of the scene in front of us. We quickly close the doors and hurriedly leave the area, fearful of being caught, exposing a shocking secret, about the sorrowful side of birthing a child.

I experience the birth of many beautiful babies as they are welcomed to earth. I feel great sadness with the birth of babies with health issues. I am shocked and dismayed when a baby is born without any cranial bones thus seeing the formation of the brain while the doctor tells the parents the baby was born dead while he throws a drape over the delicate misshapen form, suffocating the new life without any compassion, and writes in the chart that the baby was a “monster”. Most of the babies in the state are born here.

 

We have our assigned patients who we follow through their pregnancy, labor, delivery and nursery. When they go into labor we are called in no matter what time of day or night it is. There are all varieties of birth from quick and easy to long and hard and many differences in between. The mothers can be screaming out in pain with each contraction, some even swearing at their husbands who are not there with them, while others breathe easily through the process. Our job is to hold their hands as they squeeze them tightly with the pain, instructing them on the proper breathing techniques, counting the minutes between contractions, and encouraging them to push when the time arrives, it’s an intense time.

 

It is an amazing experience, to watch the baby’s head crown, and be able to catch the small one in our hands. The umbilical cord is cut, the baby is held upside down by the feet and slapped on their tiny bottoms to get them to breathe, while they scream out in shock from being yanked out of the comfortable womb they have spent the last 9 months in. While the doctor is dealing with the placenta a pediatrician has taken the baby over to the side where a sterile field is set up on a table and the baby is suctioned with a bulb syringe to get amniotic fluid out of the mouth and receives a quick physical.

 

The baby is cleaned up, showed to the mother that it has all its limbs, and then quickly carried out to the viewing room. The baby is brought to the looking glass window for a close up look by the father and other family members present, in the long rectangular room you can see a few rows of clear see through bassinets on wheels, each containing a newborn, all swaddled in soft white cotton, some are quietly sleeping while others are crying to be held and cared for.

 

The mother is cleaned up then taken to her private room to rest briefly before we begin instructing on baby care. We bring the baby to the mother and teach breast or bottle feeding, caring for the umbilicus, bathing, encouraging bonding and caring for her baby on a regular scheduled time throughout the day/night. The room is large enough for the father and other family members to visit and spend time with the new mother and child.

 

We spend time in the nurseries where we care for the little ones with love and protection. There are a few of us together caring and playing with the babies when they are not with their mothers, picking them up when they are fussy or crying, it is so much fun and enjoyable interacting with these newborns. When in ICU it is a more intense situation and we are anxious and concerned over the health issues these tiny ones are experiencing, at times feelings of helplessness overwhelm me. I see the need for touch but they are in incubators and have minimal physical interaction because of the physical barriers so we talk to them and rock the machine. We rejoice when the infant is out of danger and is transferred to the nursery.

 

The issues coming to the forefront is the nurses caught stealing pain medications from the delivery room; there are no laws about controlled substances so record keeping is all based on what has been ordered and received. It creates a major scandal throughout the community. It is no surprise to me for since I have been in nursing school the students have been going to the pharmacy for menstrual cramps and have been given Percocet like they are candy, which seems to be over kill to me. Pain medications are all over the place and easily accessible, I am lucky that I am not tempted by them for it seems easy to become addicted. I am fearful of addiction to medications and any substance that is being sold out on the streets; I remain focused on my nursing studies and not wanting anything that will lead me off my path to my goal. I have received an excellent education in obstetrics and gynecological nursing and feel confident that I could do this work after graduation without too much fear or anxiety.

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1969 PSYCHIATRIC NURSES TRAINING AT HOWARD STATE HOSPITAL IN CRANSTON, RHODE ISLAND

HOWARD STATE HOSPITAL IN CRANSTON, RHODE ISLAND

Our 3rd 3 month rotation is at Howard State Hospital.

On a hill that rolls gradually up from the Pawtuxet River across Pontiac Avenue stands the Howard Reservation, a campus like setting that includes Victorian stone structures, numerous early twentieth century Colonial Revival brick buildings, and assorted new facilities. Its story is part of the social history of all of Rhode Island, not just Cranston. The development of Howard was Rhode Island’s first attempt to provide social services statewide through publicly supported and publicly administered institutions. As such, the Howard reservation signaled both a significant change in the role of the state and a major alteration in the treatment of the poor, the mentally ill, and the criminal.

Here is what, we student nurses experienced in 1969. Still in our junior year we leave our campus and move to what we call Howard State Hospital for our Psychiatric/Mental Health Nursing experience, where we lived on the premises for 3 months. The first night is creepy and scary. The patients that have ground privileges come around the building making weird sounds to frighten us. One of the students prize herself as a psychic, who can read us, through something that belonged to us, like jewelry, creating more anxiety around the unknown.

Sounds echo in the dorms, down the halls, and my laugh carried far. Before I know it I am called back to RIHSN to the Nursing School Director and told “You needed to keep it down”. I approached the topic of the Howard’s DON’s abuse of the patients and am told “You are not to get involved, not to report it or make a commotion about it, or you will be kicked out of nursing school”.

We investigate our surroundings, going into the basement; we come across cement tubs where they use to put the patients in ice baths and keep them in with canvas tops over the bathtubs. There are huge chains attached to large circular metal rings all up and down the walls, the energy of the place is one of water torture and inhumane practices, very dark and dungy.

The DON of Howard is our instructor and she is mean spirited. In our first class, she has one of the girls; sit in a chair in front of the class, then proceeded to unbutton her uniform almost to her waist before she stops, while the student sits quietly crying. The instructor yells at her for not stopping her. We all sat shocked and in disbelief at the treatment of our peer. Mimi and I would hitch-hike to the city and once we were picked up by the Police, who told us that our instructor had been arrested for stealing, that she was a kleptomaniac, warned us to watch out for her, and then they took us where we were going. Sometimes we go out in Norma’s old Studebaker car.

It is anxiety producing entering the locked ward we are assigned to. There is three levels of care here: 1) the patients with mild symptoms who are on open wards and can come and go to work, 2) our patients with severe mental illness, who are on locked units and are never let out and 3) the criminally insane who are violent and where students aren’t allowed. We walked down a long pathway with a wooden railing separating it from the sleeping quarters on the right that had rows of single beds in a long large dorm room.  On the left side is a large open area which is the bathroom. At the end we come to 2 doors the left door leads to the nurses’ station and the main door leads to the Day room, it is a cold and uninviting space. The large day room is equipped with chairs along the 4 walls, tables and chairs in the center, and a couple of rocking chairs. The nurses’ station is enclosed, with windows looking into the dayroom and a small hole that medications are passed through to the patient, there is staff around making sure the meds are swallowed; using fingers to probe in mouths looking for pills, with those who have a history of cheeking them.

In the morning they are herded into the bathrooms made out of white tile with many drain holes for the water to pass into the sewers, white porcelain toilets and sinks and no place to hide or have any privacy. The staff is constantly yelling out what task to do, the patients act like robots: putting their pointing finger out while we place a strip of toothpaste on it and then they brushed their teeth with their finger. Without any clothes on they are forced to huddle together while taking cold showers with bars of soap, then they are allowed to dress, it is all so very humiliating my heart breaks for these poor souls.

Most of the patients have been here for many years, some have had lobotomies because of unmanageable behavior, they all appear chronically ill. They are not let outdoor and all meals are served in the dayroom with only a spoon for a utensil for no object is allowed that can be used as a weapon.

When it come to hair cut day there is a chair placed in the center of the room, while everyone else sits against the four walls watching, as everyone gets a bowl cut, if they did not go along with it they were sat on by the big charge nurse, straight out of “One Flew Over the Cuckoo’s Nest”.

The patients learned to love us for we are kind, considerate and interested in learning their story. Our last day on the unit, the staff are all lined up in the day room and the small mute woman patient goes up to the head nurse grabbed her by both nipples and twisted her down to the ground. Silently, I was cheering for the patient who had the courage to do such a thing, knowing full well that the consequences will be severe.

Psychiatric Nursing as a specialty is over 100 years old and has its roots in the Mental Health Reform Movement of the 19th Century which reorganized mental health asylums into hospital settings. Throughout the progress of this specialty, one skill that has created the foundation of psychiatric nursing is the one-to-one therapeutic relationship. It has been influenced by emergent psychotherapies and counseling skills has become an essential component in nursing education.

Hildegard Peplau developed the theoretical base for mental health nursing when she and others created the National League for Nursing in 1952 and suggested that all schools of nursing have a basic theory and practice course in psychiatric nursing. She firmly believed that the psychiatric nurse’s greatest tool was use of the self in the therapeutic relationship.

Psychiatric and mental health nursing concepts are present to us in all practice settings because the development of a one-to-one relationship is important in the creation of the patient’s trust in the caregiver. Assessment skills and communication are essential and taught in all areas of our nursing training in order to gather the information needed to make an accurate nursing diagnosis and subsequently treat the patient holistically.

We received experience and education in psychiatric nursing to provide care to an increasingly complex and seriously ill patient population through our ability to form one-to-one therapeutic relationships with the patients despite the environment we found ourselves in. Throughout history, psychiatric nurses lead the nursing profession in treating the after effects of war, disasters and the rising number of mentally ill individuals in society.

The therapeutic relationship is an abstract concept that can be defined as a planned and goal-directed communication process between a nurse and a patient for the purpose of providing care. We may counsel their patients but have not gone to counseling training. However, individual one-to-one work utilizing counseling skills is intrinsic to mental health nursing. Throughout our training we are developing observational skills, learning supportive approaches and sharing our education with patients. We are learning a non-judgmental attitude, we perceived inability to help our psychiatric patients, we feared  mental illness and when studying our Abnormal Psychology book we identified with many symptoms, we had poor role models at the State Hospital and had a lack of support in clinical settings which were all deterrents to our development.

The history of Psychiatric practice in the first part of the 20th Century did not place much stake in particular diagnostic categories. The first official manual of the American Psychiatric Association, the Diagnostic and Statistical Manual of Mental Disorders (DSM-I, 1952) reflected the views of dynamic psychiatrists. Specific diagnostic entities had a limited role in the DSM-I and its successor, the DSM-II in 1968. These manuals conceived of symptoms as reflections of broad underlying dynamic conditions or as reactions to difficult life problems. Dynamic explanations posited that symptoms were symbolic manifestations that only became meaningful through exploring the personal history of each individual. It made little effort to provide elaborate classification schemes, because overt symptoms did not reveal disease entities but disguised underlying conflicts that could not be expressed directly. For example Schizophrenia is thought to be caused by the mother.

Karl Menninger, a leading dynamic psychiatrist, viewed all mental disorders “as reducible to one basic psychosocial process: the failure of the suffering individual to adapt to his or her environment…Adaptive failure can range from minor (neurotic) to major (psychotic) severity”. Rather than treating the systems of mental disorder, he urged psychiatrist to explain how the individual’s failure to adapt came about and it’s meaning to the patient thus almost everyone has some degree of mental illness at some point in their life. The focus of dynamic psychiatry broadened from the treatment of neuroses to more generalized maladaptive patterns of behavior, character and personal problems. Mental health patients came to be people who were dissatisfied with their relationships, careers, and their lives in general. Psychiatry had been transformed from a discipline that was concerned with insanity to one concerned with normality. This focus made the profession vulnerable to criticism that it was too subjective, medically unscientific, and overly ambitious in terms of its ability to explain and cure mental illness.

The following is taken from “1970 RI Historical Preservation Report for Cranston, Rhode Island”.

In summary for the first 150 years of American history, poverty, crime, and insanity were regarded as natural components of human society; the local approach to providing social services reflected the seventeenth and eighteenth century view of the town as the basic social organization. With the coming of the American Revolution and the nineteenth century, a new philosophy evolved. It held that deviance and poverty were not inevitable but simply the result of a poor environment. The solution was believed to be isolation of the poor, the mentally ill, and the criminal in an environment that eliminated the tensions and chaos engendering deviant behavior.

Poor farms and asylums sprang up around the country. In Providence, the Dexter Asylum opened in 1828 to care for the sick and feeble, and in the 1847, Butler Hospital was opened-one of the most progressive institutions for the treatment of the mentally ill in the nation. In 1839, Cranston’s Town Council voted to purchase the Rebecca Jencks estate in what is today Wayland Park at the foot of the present Meschanticut Valley Parkway, and use it as a poor farm.

Although by 1850 fifteen of Rhode Island’s thirty-one towns had established town asylums or poor farms, their operation did not reflect the kind of progressive thinking that was embodied at Dexter and Butler. The situation of the poor and the insane poor was not only scandalous, as revealed in Thomas Hazard’s 1851 “Report on the poor and Insane in Rhode Island”, which graphically delineated the miserable living conditions of most of the state’s poor, it also reflected a continuation of the local approach to social problems. Following Hazard’s report, the legislature abolished the chains and dark rooms that had characterized the treatment of the insane in many towns.

In 1866 a state Board of Charities and Corrections was established similar to that in Massachusetts, to “devise a better system of caring for the unfortunate unlawful classes of the state”. The act provided for the establishment of a state workhouse, a house of corrections, a state asylum for the incurable insane, and a state almshouse. The board moved to consolidate facilities by establishing a “state Farm” that would simultaneously raise standards for the indigent and relieve the localities of their responsibilities. Two adjacent Cranston farms were acquired the old Stukeley Westcott farm and the William A. Howard farm further west.

Plans for a state farm reflected the adoption by the state of Rhode Island of some of the current thinking affecting social services. The selection of a pastoral site far from the city is indicative of the prevailing philosophy that many of the nineteenth-century replaced assignment of the destitute to local families. Almshouses would care for the “worthy” or hard-core poor, the permanently disabled, and others who clearly could not care for themselves. The able-bodied or “unworthy” poor who sought public aid would be institutionalized in workhouses where their behavior could be controlled and where, away from the temptations of society, they would develop new habits of industry to prepare themselves for more productive lives and less dependency.

The creation of a state asylum for the insane signaled a significant change in public policy towards the mentally ill. Unlike the earlier optimistic era in the 1840s when Butler Hospital opened, the newer prevailing philosophy assumed that many of the insane were incurable, and therefore there was little justification for providing expensive hospitals for them. Thus in planning the State Asylum, therapy was the last of the goals listed. The Asylum would offer “every facility for economical, comfortable, and perhaps even to a degree, curative care…”

In 1885, to relieve the cities and towns from the burden of supporting their insane poor, the General Assembly adopted a resolution that the State Asylum for the Insane should serve as a receiving hospital for all types of mental disorder, acute as well as chronic, thereby merging the two. By giving over the Asylum to the “undesirable” elements, the poor, the incurable, and the foreign-born, the upper and middle classes thus restricted their own ability to use it. Therapy was second to custody.

The Board’s explanation for the rise in mental illness, agreed with the views of Dr. Edward Mann, Medical Supervisor of New York City’s Ward’s Island, who was quoted in the annual report for 1877:

“Next to hereditary pre-disposition, which is the first and predisposing cause of insanity, comes the great mental activity and strain upon the nervous system that appertains to the present age and state of civilization. This feverish haste and unrest, which characterize us as a people, and the want of proper recreation and sleep, tend to a rapid decay of the nervous system and to insanity as a necessary consequence.”

In 1888 funds for a new almshouse for the insane was obtained. The older wooden structure was replaced with the installation of a large central administration building with office and residential facilities for the staff and public eating and worship spaces for the inmates who were segregated in men and women wings flanking the central structure and a cottage for the children. It opened in 1890 the three and half story stone building stands as a series of long buildings running north-south and interrupted regularly by octagonal stair towers. Its handsome stone work and the red-brick trim and its site behind copper beach trees on a bluff overlooking Pontiac Avenue make the center Building one of the most visually striking structures in Rhode Island.

The major improvement of the decade before the turn of the century was the appointment of Howard’s first full-time superintendent, which signaled the introduction of professional training, therapy oriented administrators at the State Farm. The new orientation manifested itself in the building plan for the Hospital for the Insane created in 1900, based on the contemporary practice of constructing hospitals for the insane on the cottage or ward plan, “thereby establishing small communities in separate buildings that are more easily taken care of and administered,” the plan was the first at Howard to establish a campus like quadrangle arrangement of buildings in place of one large self-contained structure. A new key part of the new plan was a communal dining room constructed in 1903 with the room measuring 195 feet by 104 feet, which could seat 1,400 people.

In 1912, the reception Hospital (A Building) was opened, intended to permit appropriate diagnosis and classification of patients as they entered the institution. In 1916 psychiatric social workers were assigned to the state hospital. The training School for Nurses was opened in conjunction with the reception building. B Ward was completed in 1916 and C ward in 1918 completing the plan for “simple and dignified” buildings and “plain red brick walls with pitched roofs, without any attempt at ornamentation”. Standing just west of Howard Avenue and opposite the old House of Correction, the quadrangle signaled the beginning of a new mode of construction at Howard-red brick buildings in a simple Colonial Revival style grouped around a quadrangle and containing dormitories, single rooms, and porches as well as treatment facilities.

In 1918 a new building was constructed for the criminally insane and additional dormitories. The old twelve foot high solid fence which shut off patients from the outside world was replaced by a lower lattice one with view of the surrounding countryside. This change alone symbolized the change in attitude which was articulated in 1929 Annual Report:

“The commission tried to save dollars, but it would rather save a man or a woman. It wants to see plants in Cranston, Providence, and Exeter a credit to Rhode Island, standing like so many Temples of Reform, Education, and Philanthropy. But it is even more desirable that its work should be represented in reconstructed Living Temples in the morals, minds and bodies of those who have been ministered to by these public administrators. For it is better to minister than administer.”

These efforts at reform in treatment of the insane were paralleled by a new attitude towards the infirmed with attention focused on the medical, not the social, disabilities of the inmates. Rehab work program was started in 1928. Patients could live with families and work in the community. Most of the patients worked the 225 acres of state farmland, harvesting far in excess of the needs of the reservation. As late as 1941, 750,000 quarts of milk, 400,000 eggs and 14,000 tons of beef were being produced on the farm.

There is a long History of overcrowded and in 1933 the State Hospital, with accommodations for 1,550, housed 2,235 and was labeled the most overcrowded mental hospital in the northeast. In the years 1935-1938 twenty-five buildings were erected for the State Hospital for Mental Disease. The appearance of Howard was dramatically altered by this construction which went up so fast the Providence Journal declared a “new skyline rises at Howard.”

Built in a uniform, red brick, Georgian Revival style, the structures comprising the State Hospital and State Infirmary are grouped in campus fashion on either side of Howard Avenue. Taken in total, the building incorporated a uniformity of style, scale, material, and sitting that is striking. Historically they represent the coming together of national policy and local initiative. Architecturally, they present one of the most lucid statements of the Georgian Revival in Rhode Island. Despite the improvements by 1947 conditions once again deteriorated due to overcrowding. In 1959 an expert from Boston declared the conditions were shameful and yet “relatively good” compared with mental hospitals in the country, due to the inability to raise capital funds to match federal programs. In 1954 there was an active public-relations effort, including pamphlets detailing the overcrowding, articles in the Journal, and radio spots resulted in passage of a bond issue. In 1962 the General Hospital and the State Hospital for Mental Diseases merged to become the Rhode Island Medical Center. The former became the Center General Hospital and the latter the Institute of Mental Health. In so doing, Rhode Island was the first state to create therapy units for its mentally ill. In 1967, the Medical Center was divided. The Center General Hospital was designated to serve as an infirmary for the prison and the Institute of Mental Health.

1968-1969 JUNIOR YEAR AT RHODE ISLAND HOSPITAL SCHOOL OF NURSING

First a brief history, of Rhode Island Hospital, which was built through the generosity of the community, begins in 1857 with a bequest by Moses Brown Ives, to establish a fund for a hospital in Rhode Island. On October 1, 1868, the founders of Rhode Island Hospital gathered on the hospital grounds to dedicate the new hospital, founded to serve the citizens of the state and to provide care to the region’s most seriously ill and injured with the latest medical technology available.

 

In 1882 Sarah Gray, the first chief of nurses, is appointed and opens a nursing school.

In 1895 The Department of Orthopedic Surgery for the prevention and cure of deformities in children and adults opens.

In 1915 Rhode Island Hospital becomes the first hospital in the region and the third in the United States to offer an EKG machine.

In 1922 A Tumor Clinic is established by Herman Pitts, MD, and George Waterman, MD.

In 1931 The Joseph Samuels Dental Center opens at Rhode Island Hospital to provide comprehensive dental care services to Rhode Island’s underprivileged children and individuals with special needs.

In 1934 Dr. Minot, Dr. George and Dr. William Murphy of Rhode Island Hospital, win the Nobel Prize in medicine and physiology for their work on pernicious anemia.

In 1941 The Potter Building opens to care for children.

In 1945 Modern research begins when the Rhode Island Medical Society approves the creation of an institute of pathology within the hospital to make laboratory services more available.

In 1948 The Trustees approve “dedicated to the care of the sick, education and research” to Rhode Island Hospital’s statement of purpose.

 

Collectively, the community supported many special campaigns, including drives to fund the $8.75 million, which is one of the first 10-story patient care buildings in the country, the hospital opened in 1955. This is the building that I was trained in.

 

In the 1800s the first uniform at Rhode Island Hospital School of Nursing was a long black dress, heavy black stockings with garter-belts, white starched pinafores, and they carried a kerosene lamp that they had to dray around where ever they went. The style changed to what our big sisters’ wore: white starched uniform with the pinafores and their caps were white starched winged things, which most schools had adopted since the beginning of training.

 

Our class is the first to have a more modern uniform that is easier to care for: made of polyester; the pattern is small pink pinstripes, which you really can’t see; there are buttonholes down the front center on both sides where 2 sided plastic white buttons go in, holding it all together. Our caps look like a paper cupcake holder upside down on our heads, that I have to hold onto my hair with 2 long pointy white hat pins that are out to get me, never really keeping it in its proper place.

 

This year we have received a thin burgundy velvet ribbon that is place on the cape to show our accomplishment of completing our first year of nursing, we are so proud of it. We wear heavy white pantyhose with freshly polished white nurses’ shoes, no deviation is allowed. Our nails have to be short, clean and without polish, our hair has to be off our collars and out of our faces.

 

Now we are big sisters to the new class that enters the school, feeling jazzed that we get to pull pranks on the newbies, and in line with tradition we do the water balloons over the doors, the saran wrap across the toilet bowl and petroleum jelly on the toilet seats. We develop a supportive bond with our little sisters and share with them what we have learned from our big sisters. We really do not get to see our little or big sisters much because we all have such busy schedules but connect when the opportunity presents itself.

 

Our class numbers is down to 75 students remaining which means 25% flunked out with a small number quitting by the end of the first year. We are in our 2nd year of nursing school and our clinical experience working with patients has increased to 4 days a week with the 5th day for our nursing classes.  It is freaky that after a slow paced year of one day of clinical a week we are now working 4 days a week and my group is thrown into the lion’s den where student nurses are eaten alive and its full steam ahead.

 

Our 1st 3 month rotation is surgery in the OR at Rhode Island Hospital. We are assigned a locker, given 2 sets of the basic green scrubs that were the only color at the time, which includes hat, booties for over our shoes, top and pants. We change into our scrubs, put on the covers for the shoes, and tie back our hair before putting on the caps. Then we enter the scrub area and are instructed how to scrub down our hands and forearms after which we keep bent at the elbows, before gowning up and putting on our gloves, now we are “sterile” enough to enter the OR.

 

Our first day starts with us above a large OR room in the Gallery watching an open heart surgery, the surgeon tried to have us believe that he is the famous Dr. Christiaan Barnard who performed the First Heart Transplant, he has us all go down into the OR room and look into the open chest of the patient, to the amazing visual of the heart beating loudly in our ears as we peek in. It was a rare thing to behold and all I could wonder about was how much outside contaminants’ the patient was being exposed to while 20+ students peered into the man’s chest, and the subsequent discomfort he will experience from the amount of time he was being held open by those large retractors pulling on his ribcage.

 

The doctors are always teasing the student nurses or trying to freak us out. The hardest thing for me is when a woman had a mastectomy and large breast is handed to me in a sterile steel bowl with the large nipple in the center like a target which jiggles like Jell-o as I carry it to the pathologist. I feel that in Surgery there is no person, there are sterile drapes placed all over the body, except where the surgery takes place, that somehow it is seen as a heart, a breast, or just some body part, in order for a human being to be able to do such a thing to another person. I wonder if some type of dissociation may take place, but I am not a surgeon, so I do not know what they experience, they are excellent at what they do, their hands are sacred, and help many people live a better life. Each surgeon has their own way of relieving the tension and stress while in the OR room some of them joke, some listen to music while others focus on the student nurses.

 

The most embarrassing moment is, when I am assigned to prepare an OR room with all sterile equipment, fully gowned and gloved, I covered all the surfaces with sterile drapes, when I get to the instrument tray and push the sleeve over the table top, both of my gloves rip, I am humiliated for I have contaminated the whole room and have to start all over. I have poor body awareness boundaries, some type of hand eye coordination problem, besides having been mostly into brain/mind focus while not been into my physical/body development. So I perceive myself as a klutz.

 

I dread the training of being the surgeon’s assistant, responsible for giving him the right instrument that he calls out for, while putting his hand out to receive it, we have learned the proper way to smack it in his waiting paw. I memorize all the instruments that are used for each surgery I assist with and do OK. We learn all the jobs that are involved with surgery such as: circulating nurse, setting up the sterile field of the whole room, autoclave the instruments to be used, assisting the Anesthesiologist and the surgeon. We have the privilege of observing brain surgery which is a long tedious process and awe inspiring to see what the gray matter looks like through the square window that has been drilled out of the back of the patient’s head.

 

We complete our OR training having matured in more ways than we could of imagined, nursing is proving to be a form of culture shock by being exposed to things the average person has no awareness of, which brings us together as a group, connecting us on a deep level, knowing we are not alone and being able to process by sharing what is going on around us.

 

Our next 3 month rotation is ICU. It has been a whole year and now we are allowed to be the medication nurse for the ward, after a great deal of pharmacology classes and experience on the floors. I find myself being the death nurse for whenever I walk into a room when someone is near death, they start flat lining and seeing I am the first person to arrive I start CPR and within a few minutes there is a group of people around the bed working to save a life. I am teased by the staff that will send me into a room to initiate the process, this is very anxiety producing, and I do lots of wondering about what is going on that I am not seeing and why are they encouraging it. I do all the right things and am relieved when this rotation is over while looking forward to our Psychiatric/Mental Health rotation next.

1967-1968 SOPHOMORE YEAR AT RHODE ISLAND HOSPITAL SCHOOL OF NURSING

1967 HIGH SCHOOL GRADUATION PICTURE

I am 18 years old going on 19. My mother is driving me from Pawtucket to Providence on the 95 freeway; in the car she makes a statement “My experience has been you will not enjoy sex till you are 50”. I guess this is her way of talking about sex, I am silent, not knowing how to respond, and taken by surprise. I am still dating Joe and remain a virgin. I have read medical books and novels about sex. I am not comfortable discussing the subject with my mother. Are you able to talk about sex with your mom?

 

We arrive at Rhode Island Hospital School of Nursing off of Eddy Street in Providence. We make our way to the beautiful old fashion assembly hall made out of wood: the stage, walls, floor and chairs. We are attending orientation when one of the instructors talks about “some girls will quit, and I encourage the parents to be supportive of the decision, when it is expressed, and not pressure your daughter to stick with it”. My mother turns to me and says “you will not quite, you will finish and become a nurse”. We are told that 25 % will flunk out, and we have 100 students in our class. My anxiety is compounded with this statement.

 

We go to my private room which already has a single bed, bureau and a small desk, she helps me decorate: putting up curtains, placing a rug in the center of room and a few mementos from my Dad; a foam pillow that has decomposed over the years and an old fashion favorite radio that does not get good reception; these items are hard for me to let go of, besides being beyond useful they are still comforting. She leaves and I begin by exploring my surrounding and meeting my classmates.

 

The student nurses quarters consist of 2 building for sophomores and juniors; my room is in Aldrich house and the other one is called Middle house, they are situated behind the hospital and made out of red brick probably built in the late 1800s. The elevator has a large heavy outer door that you can only open when the elevator is there and has stopped; there is a manual metal latticed door that you squish together before and after getting in and out of the claustrophobic contraption, which has you wondering if it will work. As you come off the elevator, turning right into the long corridor, you will find the communal bathroom on the right side furnished with wooden stalls separating a few toilets that are equipped with old fashion locks for privacy, there are many sinks with mirrors in a row, and a huge bath tub area.

 

The old beautiful wooden interior, of the long hallway, has high ceilings, so sound travels amazingly well. The door to each room is solid wood, with a window above that can be opened for circulating air on those hot muggy nights. My room is humongous with a large walk in closet and  a window looks out back into the trees and neighborhood. I feel right in the center of things, and can see everything going on down the long passageway, which is the main thoroughfare, that has many rooms on both sides; I am at the crossroads of two halls, the other hall leads to a corner room and in the opposite direction it leads to the lounge: where there is a TV set, a small kitchen, lounging chairs, couches, and a kitchen table with chairs, which is where many congregate to share stories and socialize.

 

I live on a floor with many other newbies, and we meet our big sisters, who initiate us by wrapping saran wrap on the toilet seats so we wet ourselves peeing, and placing water balloons to break when we opened our doors getting me drenched. A few of us get together looking for their pranks before going to bed. They told us that our life will change drastically and the boyfriend we have now will not be around at the end of the year because we will have changed. They end up being right because I end my relationship with Joe within a few months.

 

I connect with a group of 5 girls: Debbie, Donna, Marlene, Meme and I. Together we: studied, eat breakfast, lunch and dinner in the cafeteria, and created our own study group. Whoever is good at a  subject helps those who aren’t; it works out pretty fairly, seeing we are all bright women with great minds. We figured out our nicknames, by taking the last name and using its opposite meaning; for example mine is “Weakie”. We developed a strong bond that gets us through difficult times. There is a tiny powerful housemother who goes around before 10 pm when we are to be in our own rooms, instructing us on being quite and within a short period of time, she is taking our names down because we are noisy and I am hiding my friends in my closet. We are very amused by her and imitate her when she turns her back to us to write our names down.

 

Most of the walking around campus and the hospital grounds is all done in the tunnels underground. We tend to stick together due to the dark dank atmosphere and explore every nook and cranny in order to get familiar with our surroundings, we know where the morgue is but it’s locked and that means mystery and curiosity. The entrance to and from the hospital is locked so we push the button and the housemother at the main desk buzzes us through.

 

Our first year of clinical started out slow. We spent 2 weeks on how to make a bed on an empty ward, by the tallest woman nurse I have ever known, we have a great giggle when she pulled the sheet so tight that it ripped apart, our hospital corners were assessed and the tightness of the bottom sheet is evaluated by the ability of a penny to jump up when made right. This was before we were ever allowed on a hospital unit and able to touch a patient.

 

Our first year is learning the foundations of nursing; we have clinical sessions one day a week. The night before we go to the hospital floor to look up our patient assignments, going through the chart writing down all information presented and making sure nothing gets missed. Then we go to the library and our rooms to research what it all means, which takes a great deal of our evening time. We prepare by gathering information on: any possible questions the instructor may ask about the patient; the meaning of lab results; understanding of the disease process; surgeries performed, preparation for tests and surgeries that will be happening, with the nursing care required and why; the medications being given and reasons; and to develop a nursing care plan which includes physical, mental, emotional, intellectual and spiritual needs.

 

We arrived on the assigned floor at 7 am and received report on our patients from the nurse in charge. The most anxiety producing part of the day is the interaction with the instructor questioning us on what our nursing care plans are for the day shift and answering any questions we have for her. We literally staff the hospital, except for the medication nurses on each wing and the Senior Student Nurses who are learning on the job as charge nurses. We assist the medication nurse by administering medications to our own patients. We set up the patients for breakfast; sitting them up with the over-bed table in place; delivering the hot food trays and removing the lids, placing everything within reach, with straws in the liquids; constantly assessing and anticipating the patient’s needs; and feeding those who need help.

 

We do full bed baths, always being aware of the importance of privacy by keeping the person covered with a large bath-blanket, except for the body part we are working on, we used a basin, wash cloth and large towel, changing the water frequently before it cools off. We begin with the person brushing their teeth then handing them the facecloth to do their face, if unable we do it for them, before we proceeded to their body. We work on each arm, then the chest and belly, then each leg, and if they are able we hand the person the facecloth to do their private area, otherwise we do it. At this point we changed the water and assist with turning them onto their side or by using the pull sheet. We wash the whole back and buttocks followed by a full back massage from the neck all the way down to the end of their buttocks. If they are bed-bound we change the linen at this time. Then we turned them onto their backs again and assist them into a Johnny gown. If not bed-bound we get them up into a chair, making sure they had a water pitcher, call button and anything else they required and soak their feet while we make the bed.

 

When it is lunch time we go through a similar ritual we used for the morning meal and assisting as needed. After meals we eat our lunch, which are staggered so there is always a few sophomore students around to cover the floor while a few are eating. We are very supportive and learned to work well with each other, helping to care for the more difficult patients together like when it takes more than one person to move someone. We walk with those who have orders to do so, helping those to the restroom who had bathroom privileges, and responding to call buttons for use of a bedpan. We help those back to bed that have sat up all day and give another great back massage before we chart, give report to the charge nurse and leave around 3:30pm, so the patients are basically ready for the evening shift. Our care is compassionate, sensitive and excellent and within that first year we function as a well greased machine with a strong team approach. The more we learn the more difficult our patient assignments get, we do 3 month rotations in different wards in the hospital: learning all aspects of medical, surgical, orthopedic, and neurology nursing care.

 

Four days a week we attended classes: which include nursing theory with our own nursing instructors; and non nursing classes from the University Of Rhode Island instructors who come to our campus to teach us. Almost all our classes have a lab class attached to it. In our nursing classes we use holistic nursing care plans on whatever area of nursing we are learning about covering mind/body/spirit.

 

When it comes to anatomy and physiology we all take a system, using my room’s wall as a chalk board to draw on, and explain it to the group. In anatomy lab we work hard studying for 2 weeks, memorizing the bones of the body, using the skeletons in the lab. We study so hard all the way up to the day we take the test. Later we realize we have over studied creating anxiety and confusion. So before our next test we decide to go out and party, feeling that we needed to relax and see if that worked better, which it does so before a test ritual. Our muscles test is just one essay question to describe the muscles used and how used when doing a pushup, which is every muscle in the body extending and contracting. In lab Meme and I: dissect a cat we call dog; we pith a fog much to our disdain; and waste many clams doing chemical tests on their hearts while we had them hooked up to a small graph machine that records the heart rate.

 

On the first day of Chemistry lab the teacher instructs us on the 3 rules: keeping the water in the sink, no breaking anything, and no laughing. Well Mimi and I work together, she knocks the rubber hose attached to the faucet out of the sink, while rinsing out our supplies, causing the water to spray out wetting me, I drop and break the beaker, and we both burst out laughing. This puts a stress on our relationship with the lab instructor: when she would ask questions like “I don’t get that, can you explain it?” he’d response with “you’ll never get it”; and when she got her test papers back we could always find a right answer marked wrong and she’d have to point it out to him. Thank God high school gave me a great foundation in chemistry and since I excel at it I pass. In microbiology lab I contaminate everyone’s Petri-dish with my organism; luckily I did well in those lectures and pass. In the college classes the lectures and lab scores are always combined and as you can imagine the lab scores brought down the excellent scores I get in the lectures.

 

We go out at night walking arm in arm, singing and dancing down the street to the tune “we’re off to see the wizard, the wonderful wizard of oz”. We walked through downtown Providence on the way to the Eastside which is called College Hill and hang out. We get involved in the International Student Union where we meet people from all over the world. We have Hot Fudge Sundays or bagels and cream cheese at the little Bob’s Big Boy. We have a 10 pm curfew on weekdays and midnight if we stayed in the dorm on the weekend, which I preferred and do frequently. We only get 2 weeks of holiday vacation and two weeks in the summer off from our training schedule, so we make the best with whatever free time we have. Can you identify with any of my experiences, how are yours different?

 

 

ALDRICH HOUSE