Untangling Typhoid: Comparing Early 20th Century Instruction for Quality, Evidence-based Nursing Care
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Overview of the topic: This paper examines whether the curriculum of the Chautauqua School of Nursing (CSN), an early 20th century correspondence course, offered a quality, theoretical foundation for professional nursing practice at that time. Examination of the curriculum includes evaluation of the accuracy and adequacy of the content needed to provide quality, evidence-based nursing care. Comparison of CSN’s instruction related to the care of patients with typhoid fever to the instruction provided in nursing textbooks published during the same time will be discussed. Historiographical literature on the topic: CSN claims to have enrolled tens of thousands of students during its 34-year tenure. Organized nursing adamantly opposed CSN largely due to the absence of required nurse-supervised practical training although many CSN students gained physician-supervised practical experience in private duty cases. Due to organized nursing’s opposition, CSN receives negative or no mention in the nursing history narrative. Within a few publications at the turn of the 21st century, CSN received positive mention for its innovative approach to educate nurses; however, a comprehensive evaluation of the educational quality of the CSN correspondence course has not been published to date. Because a patient’s recovery from typhoid fever at the turn of the 20th century was largely dependent on the nurse’s intelligent and skilled care of the patient, typhoid fever content was selected as the instruction to compare. Methods: This historical case study was carried out using a social history framework. Primary sources for CSN, including lessons (1910) and narrative patient case stories, were used from the Archives of the Foundation of the New York State Nurses Association, Bellevue Alumnae Center for Nursing History and the Fenton Historical Society. A Text-Book of Nursing for the Use of Training Schools, Families, and Private Students by Clara Weeks-Shaw (1905) and Nursing: Its Principles and Practice for Hospital and Private Use by Isabel Hampton Robb (1909) were the nursing textbooks used. Secondary sources, including historical and contemporary professional journal articles, and analytical books on the subject, validated, enhanced, and confirmed findings. Summary and Implications: Comparison of the instruction in the CSN course and the two nursing textbooks did not reveal major discrepancies in the description of the progression of the illness, presenting symptoms, or key points for patient care. The CSN lecture provided a more detailed description of the pathophysiology and potential complications of the illness, and of the nurse’s care of the patient than the nursing textbooks. All three sources emphasized the importance of the nurse to provide careful and meticulous observation, disinfection, nutrition, and management of the patient for the patient’s recovery. The instruction for nursing care of the patient with typhoid fever in the CSN course and the nursing textbooks align with the discussions and patient case stories published in the American Journal of Nursing during this time. Based on this comparison of typhoid fever content, the CSN curriculum provided instruction to provide evidence-based typhoid fever nursing care at that time. CSN deserves a place and space within the nursing education history narrative. *Research for this work was funded by the American Association for the History of Nursing, H-15 Grant.
