This article first appeared in November 2004.

Dr. Martin Duke’s poignant article “Once upon a time, there was little black bag” brought to mind that we as visiting and public health nurses also carried a little black bag. Only we were making “home visits,” and the doctors made “house calls.”  Maybe our nomenclature was a telling difference between the professions, our particular missions and goals, and our respective relationships with our patients and families. Both of us, of course, were welcomed by families as friends, but the expectations and outcomes, while complementary, were relatively focused on each profession’s primary goals. The physician’s goal was to diagnose and cure patients, and the nurse focused on providing care and comfort. Not that nurses didn’t diagnose, but those diagnoses were always carefully couched in terms acceptable to that fine line between territorial domains. I can remember discovering Koplik spots (early signs of measles) in a child’s mouth and teaching the mother how to identify them, prevent secondary sequelae, and protect her other children; I also explained the criteria for seeking a medical consultation. Furthermore, I added the information to the Public Health Department’s information database on communicable diseases, informed the mother that I would contact the school, and established a follow-up plan.

Still, like physicians, we nurses in navy blue uniforms were recognized by our little black bags. Indeed, there were rituals that were followed by nurses and, more often, by the families familiar with them. The black bag was always placed on a newspaper on a working surface, most often a kitchen table. More newspaper was then folded to make a small bag—much to the delight of the children—for disposal purposes. The black bag contained a white apron, bottles of soap, alcohol, acetone, some testing materials, rubber gloves, and hand towels, among other supplies. Procedures for handwashing and for opening and closing the bag were strictly followed. These rituals provided many opportunities to teach families about infection control, environmental cleanliness, and safe disposal of contaminated materials.  These teachable moments allowed us to transfer knowledge and translate problem-solving skills into behaviors that could last a lifetime and create a healthy way of life. If children were present, we initiated learning experiences for them, often supporting the efforts of their mothers and teachers. We would wash our hands together while singing that primary grade song, “This is the way we wash our hands, wash our hands, wash our hands, this is the way we wash our hands early in the morning.”  

It was always amazing to me how the perception of a person and his or her family that had been formed based on an episodic clinic visit could change during a home visit. At the clinic, the staff is in charge and serves as the host, although many “hosts” forget that! As home visitors, we viewed ourselves as guests in our families’ homes, respecting their personal and religious beliefs, cultural traditions and practices, and social and political positions. We were often impressed with their strength and stamina in dealing with the stresses of living, their creativity in handling hardships, and their bearing up under tremendous personal, social, and financial disappointments. In many ways, these families were our greatest teachers. We learned so much from them, and they gave us so much more than we were ever able to return. Still, the home visit was an opportunity to fulfill the mission of public health. We not only performed the necessary clinical functions but also included the preventive and promotional aspects of public health programs, including environmental, epidemiological, and aggregate population health planning, plus other broad aspects dealing with the public’s health.  

Those were the days my friend, I thought they’d never end…

References

1. Duke M. Once upon a time, there was a little black bag. Pharos Alpha Omega Alpha Honor Med Soc. 2004;67(3):14-16.