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liberal in space, kindness and diet. Avoid the nursery where
yon are kept on the doorstep while yon enquire, where there
is little play material, and children sit round apathetically
arranged on chairs. You will find such nurseries to be in a
minority, but they do exist.
At the end of the year 39 day nurseries and 19 childminders
were registered under the Act for the care of 1,646 children.
Domiciliary
Nursing
Attachments
General medical practice and the domiciliary nursing services
both seek to treat the sick person in a domestic background.
'Attachment' schemes aim at promoting a more rewarding
and productive relationship between the two professions.
In these schemes the nurse works with her own doctors,
and visits their patients wherever they may be within the area.
The boundaries of her work are the boundaries of the practice
and she may travel widely. She is only responsible clinically
to the doctor, and reports back to him regularly so the patients
may be fully discussed. In some attachments the nurse may
help the doctor at his surgery providing this work requires
her professional skills. She is not a substitute for a receptionist
nor is it her job 'to pop round the corner as the doctor hasn't
time and make sure Willy Smith hasn't broken his leg'
Meeting doctors regularly, talking over cases, being told the
reason for treatment, side-effects to watch for, response expected,
should enrich her intellectual life, and give her
profession more meaning.
The doctor should gain much from the observations she
passes on to him about his patient, as good nurses have an
amazing faculty for assessing home situations and the total
effect of illness on a family.
The same case can be made for attaching midwives to
general practitioners and in Redbridge we are always pleased
to hear from doctors who would like to discuss an attachment
scheme in their practice, either of a midwife or a domiciliary
nurse.
I have reservations about full attachment of Health Visitors.
Apart from their domiciliary work with young children and the
aged they run child health clinics, supervise ante and post
natal clinics, run relaxation classes and are deeply involved
in systematic health education in the schools. They have the
arduous and increasing burden of visiting Day Nurseries and