At the dawn of the children’s hospital movement in Europe and the West (best epitomised and exemplified by the opening of London’s Great Ormond Street Hospital for Sick Children (GOSH) on 14 February 1852), the plight of sick children was precarious at all levels of society.
After a long campaign by Dr Charles West, Great Ormond Street hospital was the first establishment to provide in-patient beds specifically for children in England. Rather telling of attitudes at the time, the clinic originally opened with just ten beds. Despite this, it soon grew into one of the world’s leading children’s hospitals. This was helped with the patronage of several wealthy and high-profile individuals, most notably Queen Victoria, and the famous author Charles Dickens; a personal friend of Dr West.
In 1854, after three years of activity, West (who was also the first physician of the hospital) could describe its initial success. He was also quick to point out the major shortcomings plaguing children’s health care:
The poor now flock to it [Great Ormond Street], sick children from all parts of London are brought to it. […] But still the want of funds limits the numbers who are received into it, and only thirty beds can be kept open for in-patients. Thirty beds! When more than 21,000 children die every year in this metropolis under ten years of age; and when this mortality falls thrice as heavily on the poor as on the rich! But alas, the tables of mortality do not tell the whole of the sad tale. It is not only because so many children die, that this Hospital was founded; but because so many are sick; because they languish in their homes; a burden to their parents who have no leisure to tend them, no means to minister to their wants.
In the mid-nineteenth century, nurses had little access to textbooks and journal articles, and what little was available was written solely by medical doctors. The first English paediatric textbook for nurses was also written by West; entitled How to Nurse Sick Children, in 1854. Like the hospital, it was a great success and brought him considerable fame. Ironically though, later in the decade, West corresponded with Florence Nightingale – asking for advice on how to nurse sick children! This was particularly ironic because Nightingale had no experience of nursing sick children. Despite this, in her famous Notes on Nursing published in 1859, she stated that “children; they are affected by the same things (as adults) but much more quickly and seriously.”
Given the aforementioned lack of nursing texts for children, Nightingale’s text became a cornerstone of the curriculum at nursing schools across the country. It also sold well amongst the general reading public (West’s “parents with no leisure”), as it was written specifically for the education of those nursing at home – and is still considered a classic introduction to nursing.
In the introduction to the 1974 edition, Joan Quixley of the Nightingale School of Nursing wrote:
The book was the first of its kind ever to be written. It appeared at a time when […] hospitals were riddled with infection, when nurses were still mainly regarded as ignorant, uneducated persons. The book has, inevitably, its place in the history of nursing, for it was written by the founder of modern nursing.
Today, we all know that the assessment of the deteriorating sick child is difficult, and children’s nurses rely on clinical instruments such as PEWS (Paediatric Early Warning Scores) and SBAR (a structured method for communicating critical information that requires immediate attention) to measure acuity. But they also need access to quick and reliable, evidence based protocols to provide optimum care delivery. The Care Quality Commission (the health care regulator for England) expects that care delivery will be safe, effective, caring, responsive, well-led, and importantly, predicated on best evidence. Even at Great Ormond Street today, the home of paediatric care, there can still be problems. Systemic issues still get raised, including incident reports for things such as notes unavailable for clinic, children not booked in in a timely way, waiting times and lack of follow-ups. Ensuring these problems are not repeated necessitates attention to those who have gone before us.
Whilst it would be impossible to foresee the shape or configuration of children’s nursing in the future, we recognise that the frontiers of health care for children are changing at a phenomenal rate. Building on the precedents set by pioneers such as Charles West and Florence Nightingale, the field is continuing to progress rapidly. We still face significant challenges however. Issues such as the prevalence of childhood obesity, the onset of type-2 diabetes, the increase in mental ill-health during childhood, and the re-emergence of diseases such as rickets, are all linked to the way in which we as children’s nurses have to be resilient and adaptive to children’s health needs.
It is for reasons such as these, that it is so important to put clinical care into context – helping us to understand the origins of the field, and thus provide child policy recommendations for the future.