District nursing : professional skills and knowledge in domestic settings : linking national and local networks of expertise 1866-1974
This research produces a deeper understanding of the transition of district nursing from nineteenth century voluntarism to the twentieth century welfare state, with particular emphasis on Leicester within the context of the national scene from 1866 to 1974. The thesis takes Leicester as an example of urban society to explore the collective attributes, networks of expertise and the initiatives that promoted the development of a district nursing service for the sick in their own homes. The evidence shows the challenges presented by limited human and financial resources; reveals the range of skills and responsibilities practised by district nurse; traces the course of professionalization through the adoption of national standards; sets out the biographical characteristics and career rhythms of Queen's Nurses, a sub-set of district nursing; and highlights the contribution made by district nursing to the empowerment of women. The study exposes the shifting and often contradictory attitudes of society towards district nursing. District nursing was most valued by the recipients of care and by people closest to the service in the community; it was least valued by those who were not in direct contact with district nurses and had little appreciation of the expertise involved. A most telling finding was the attitude of the government and the extent to which that attitude threatened the development of district nursing through a lack of recognition of the skills and responsibilities involved. The research shows that throughout the three phases of transition, 1866 - 1908, 1909 - 47, and 1948 - 74, district nursing rose above constraints and hostile policies to build on the traditions and values that lay at its core. The evidence makes a contribution to social policy and the social history of health care in Britain, and points to significant issues for future research and social policy decisions.