Bringing health to the community; This year marks the 150th anniversary of the birth of district nursing charity, the Queen's Nursing Institute. Emma Pinch talks to two district nurses who covered the city, past and present.

Byline: Emma Pinch

EVEN with rain pelting her face and sturdy iron bike weighing a ton as she heaved it up Parliament Street, as a district nurse Beryl Delve maintained her strict sartorial standards.

Black lace-up shoes, black stockings and stiff starched collars, which had a tendency to dig into her neck at times like this.

It reflected pride in their profession, of course, but in Liverpool they were the smartest in the country.

"We had to be very immaculate in our uniform, especially in Liverpool, because we were all very aware it was the cradle of district nursing," says Beryl, who qualified in 1951. "We had it shovelled into us."

But the era left its mark when it came to career choices when she left school.

You had to do something the country needed," she says, slightly wistfully, reflecting she'd have quite like to have been a journalist.

"The war was on and if I didn't choose nursing the Government would have put me in the Army or WAAF."

The training was long and arduous. She qualified in London after five years then came home to Stoneycroft, Liverpool, to look after her father who had come out of the Navy with emphysema after his boat was torpedoed at sea. She took further training as a district nurse.

When he died a year later, she was duty-bound then to care for her mother.

"I was just trying to do the right thing," says Beryl, 81.

"Daughters cared for their elderly parents. There weren't so many nursing homes for the elderly or hospices then.

"There were a lot of single women around then, because a lot of the men didn't come back.

A lot remained single."

But it meant she could throw herself into her work which, despite the restrictions of the uniform, offered freedom.

Her team of 10 would meet their superintendent at 8.30pm at the district office who would then hand out jobs. At 9am, they would sally forth on their bikes, vast leather bags strapped on rattling with equipment.

"We didn't wear caps, we were issued with storm hats which we could pull down over our ears when we were cycling about, because it could be very cold and wet. It could be very tiring getting to patients, because Liverpool is quite hilly. You couldn't go from house to house according to who was the nearest - you first went to people who were most seriously ill and you were criss-crossing the area all day. I must have covered the length and breadth of Liverpool.

It wasn't like Holby City.

Christian names weren't tolerated, and, as for all the romance, nothing could be further from the truth."

First task was always the diabetics, who needed their injections of insulin so they could begin their day.

"We'd give all sorts of injections, like iron injections for anaemia. We didn't have those throw-away syringes. They were glass and metal and we had to boil them up on people's cookers to sterilise them. Everything was done in the kitchen."

Dressings changes - bandages boiled and re-used - catheterisation, and washing and turning of bed bound patients were routine. The likes of MRSA was practically unheard of, Beryl says.

"There was lots of TB in Liverpool then. We had to go round testing sufferers' urine to find out whether they were taking their medication. We were given special gowns to wear in the home, and our hands were sore with wash, wash, wash wherever we went. Now it's all gels. Such a waste, I think."

Without so many treatments to offer for cancer, nor hospices, nursing cancer patients at home was common.

They were issued with morphia to administer to help sufferers sleep, sometimes visiting with it twice a day.

"I would have loved to have been married and have children but the men were all lost in Dunkirk," says Beryl.

"But, because I didn't have a husband to go home and make an evening meal for, I just pressed on. I got home at all hours. It meant you could work without clock-watching."

Pedalling home, she'd often be waylaid by new emergencies.

"I can remember, in a very poverty-stricken house, a man haemorrhaged all over me, he coughed and bled all over me.

Very few people had telephones then, there was just a lane then a row of shops.

"I flew down the lane to a shop and said I needed them to contact the doctor as soon as possible.

"When I got back to the house, the man had died.

"There was lots of drama every day. But you sort of got on with it because it was commonplace." Mostly people were very grateful to see her. "A few would say, 'wouldn't you like to be in a hospital and be a real nurse?', but they just thought they were being kind."

After 10 years in the city, Beryl moved to Cornwall. A year later her mother asked if she could live with her. In Cornwall, she continued to nurse "in the district" then studied to become a health visitor and midwife.

"The difference between Liverpool and Cornwall was noticeable.

In Cornwall, they didn't even wear hats, and it didn't matter what colour stockings they wore. It was shocking in comparison with what I knew.

It's tempting to say it was better in the good old days, but in district nursing it was. We didn't try to be mini-doctors. I was very proud to be part of the district nursing service."

Caring for the carers

DISTRICT nursing began in Liverpool in 1859, when William Rathbone VI employed a nurse at his own expense to go into the homes of the sick poor and provide skilled nursing.

He later set up a training school in Liverpool, and founded the Queen's Nursing Institute.

Today, the QNI continues to improve care for patients in the community by funding nurses' projects aimed at improving care, and providing them with professional information and resources. They also provide financial support for district nurses who are no longer able to work, mainly through illness, injury or age.

FOR information on the QNI, go to www.qni.org.uk

It's a privilege

ELEANOR EDWARDSON, 29, always wanted to be a district nurse. She graduated in 2000 at Liverpool University.

The patch in south Liverpool she shares with 10 or so other nurses covers Aigburth, Dingle and Toxteth.

Cars, disposable equipment, satnavs and mobile phones make her job different in the details.

"We see absolutely all of life doing this job. You have to be non-judgmental and be prepared for anything."

She'll make two or three calls on her way into the office to see diabetics, and make a total of eight or so visits a day, travelling in her trusty Ford Focus. The boot is packed with blood pressure machines, weighing scales, sterile towels, gloves and dressings. Her uniform is a navy tunic, fleece and waterproof coat.

"Wound care is a huge part of it, for people who are housebound, which may be leg ulcers or immobile patients with pressure sores, traumatic or post-operative wounds. Ten years ago, people would be managed in hospital for longer, particularly post-operatively.

Today, the aim is to get them out."

Complicating factors like substance addiction and poor diet mean people tend to have a more complex mixture of health problems, says Beryl, with wounds taking longer to heal and tissue damage setting in.

To combat infection, she might set up an antibiotic IV lines for an hour or hour and a half, following orthopaedic surgery where infection has set in.

Simple enough in a hospital perhaps, but treating in the home carries its own challenges.

"You'll be working round pets, trying to get the dog out of the way, or fighting past clutter to get to where the patient is. If they have diabetes sometimes, I have to get rummaging in cupboards to find out what tablets they are taking, and search the kitchen for pots or pans to use as basins."

The variety of communities she treats also presents its own challenges. She recounts a man in the Chinese community with diabetes suffering from acutely low blood sugar.

"A diabetes sufferer in the Chinese community ate a Chinese diet and my colleague was looking for something to give them to get their blood sugar up to normal. Everything in the fridge was totally alien, with writing she couldn't understand.

"Now we carry a few Mars Bars with us."

In the Somali culture, she had to get used to communicating with large families who wanted to be involved in the treatment of any member, coupled with language barriers. "You also plan so you don't visit on religious days."

The emotional challenges remain much the same as in Beryl's day.

"You may feel a patient is not coping round the house. You might feel they're at risk, but they're quite happy as they are, and decline help you are offering."

About 40% of her work is end-of-life care, she says.

"It could be just after they've been diagnosed, arranging for their needs, like special beds, and how they'll manage the rest of their lives, right though to supporting their death at home and, washing the patient and administering pain killers. If you're looking after them for a long time you get to know their family.

"It becomes quite intense, but it's also a privilege. I wouldn't want to do anything else."

We were all very aware it was the cradle of district nursing

As for all the romance, nothing could be further from the truth

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CAPTION(S):

Jobs were handed out at 8.30am by the superintendent at the district office, and then the team of nurses would criss-cross the city on their bikes, helping the sick and housebound; main image, district nurse - 'A friend visits the family' - from a 1949 promotion