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Florence Wald - Nurse Leader

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Florence Wald, RN, MN, MS, FAAN, Dean Emerita of Yale University School of Nursing and visionary leader of the American Hospice Movement.

She was born Florence Sophie Schorske In New York city on April 19, 1917 to Theodore Alexander Schorske and Gertrude Goldschmidt Schorske. She was the younger of two children and having pneumonia as a child, credits the superb comfort and care from her mother and a homeopathic physician as her reason for choosing to enter the nursing profession. Her parents were both highly educated, both had lucrative employment (father-banker, mother-shipping management), and were dynamic social and political activists. Her family easily survived the challenges of The Great Depression and was able to provide a good life and education to both their children. With this early good parental influence, a fine educational and working career, and good old fashioned open-mindedness and hard work, this little girl went on to ignite the modern hospice movement in the United States of America.

Before the modern hospice movement, ways of caring for the dying and terminally ill existed and evolved through the centuries. Some pre-Medieval cultures provided group support for the dying while some responded with isolation. Treatment, if provided at all was left to the "wise" or "medicine" man - a man or woman with mystical or spiritual powers. During Medieval times through the 17th century, hospice (meaning to host a guest or stranger) care was generally provided by caring family or Church(Christianity) members without the benefit of any effective medical standards or techniques. As early medicine evolved, the terminally ill were treated in crude hospitals where germ theory was still unknown and where infection and death were oftentimes proliferated rather than quelled. As a result hospitals gained the reputation as "houses of death" and families soon preferred to keep their dying at home where they could at least provide some rudimentary comfort and support. As Florence Wald was developing her nursing education in the WWII era, medicine had made great strides, particularly in the areas germ control, overall medical knowledge, understanding disease processes, and patient management. Post-WWII medicine and hospital care had a strong focus on curing disease and the terminally ill patient challenged that mission. In a time of where technology could now control ventilation, defibrillation and resuscitation, physicians and nurses oriented to a medical model of practice saw dying patients as failures and often placed these patients at the end of the hall. Families were typically kept at bay with limited visiting hours and minimal inclusion in the direct care of their loved ones. The dying patient did not fit well in the medical model that emphasized curative care. With this backdrop, let's talk more about Florence Wald.

Florence earned a Bachelors degree from Mount Holyoke College (a liberal arts woman's college in Massachusetts) in 1938 and three degrees from Yale University: Master of Nursing, Master of Science, and then an honorary degree of Doctorate of Medical Science. She began her career in the New York Visiting Nurse Service and then accepted a position teaching at Rutgers University. Wald joined the Yale School of Nursing faculty in 1957 and one year later was chosen to be Dean. She served in the role of Dean for nine years. She married Henry Wald in 1959, whom she credited as being wonderfully supportive husband throughout her life.

In 1963 Florence attended a lecture given by Dr. Cicely Saunders who pioneered the European hospice philosophy of palliative care for terminally ill patients. Inspired by Saunders, Wald immediately began reshaping the nursing school curriculum at Yale to put more focus on patients and their families and to emphasize care of the dying. Wald said of Saunders, "She blew me away." "Until then, I had thought nurses were the only people troubled by how a terminal illness was treated."

Saunders became Wald's Mentor and friend. Florence left her position as Dean at the Yale School of Nursing in 1966 and began working with others to introduce the European concept of hospice care to the United States. In 1969, Wald travelled to London with her husband and completed an intensive one month internship at Saunders' newly founded Saint Christopher's Hospice. Upon her return, Florence worked with colleagues in New Haven Connecticut to design a hospice where the patient and family were at the center of care. Co-founders of the hospice included an multidisciplinary team consisting of Katherine Klaus, RN; Rev. Edward Dobihal, Jr.; Father Canny, Catholic priest; Morris Wessel, pediatrician; Ira Goldenberg, oncologic surgeon. Mr. Wald had left his engineering firm and returned to Columbia University to earn a degree in hospital planning. His master's thesis became the proposal for the Hospice design.

In 1974, Florence and her team founded the first US hospice, Connecticut Hospice in Branford. At first it began by offering only in-home care, and in 1980 it built its own inpatient facility. It quickly became another prominent world-wide model for hospice care. It reflected a holistic and humanistic philosophy of care for the patient and immediate family.

The emphasis at Connecticut House was on symptom management and creating a caring community around the patient. The patient and family were included in all decisions. Their goal was to maintain dignity and the highest quality of life as the developmental



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