Patronage

PATRONAGE (French patronage—observation, patronage, care), usually organized observation of a child's development and upbringing in a home environment. The word "patronage" must be distinguished from "patronate" (see Foundling), which is understood as the system of placing foundling children into worker and peasant families for upbringing. History of the development of patronage. The rudiments of patronage arise in Europe by the beginning of the 20th century. In England, the patronage system develops gradually from sanitary housing inspection; female sanitary inspectors begin to fulfill the role of sisters of sanitary-educational patronage (health visitors). Somewhat later, the institution of patronage nurses appears in the USA. In Germany and France, the emergence of systematic patronage dates to 1915–1920. As a rule, in Western Europe, patronage develops from individual initiatives; the functions of sanitary-educational patronage are performed by charitable ladies from bourgeois society, and only gradually by the 1920s does the system of sanitary-educational and medical patronage, which exists at the present time, unfold. In pre-revolutionary Russia, the first attempt to introduce patronage must be considered the organization of home visits to children in Riga in 1911. Further, patronage work is introduced at the Vasileostrovskaya consultation in Leningrad (1912) and at approximately the same time at the 1st consultation in the city of Moscow. After the October Revolution, along with the powerful development of institutions for the protection of maternity and infancy, patronage receives wide distribution and becomes an integral part of the work of consultations and nurseries. The main task of sanitary-educational patronage at the present time is the establishment of a close connection between the child's family, on the one hand, and the consultation or nursery, on the other. Only by winning trust, only by establishing an intimate connection with the family through a patronage nurse, does the consultation receive the opportunity to influence the mother, father, and other persons surrounding the child in the matter of his proper care and upbringing. Patronage nurses, becoming acquainted with the conditions in which the child lives, systematically visiting a worker or peasant family, practically teach mothers at home the rules of feeding, care, and the pedagogical regimen of the child, eliminating noticed shortcomings. The second task of patronage is the attraction of children to the consultation in the earliest possible period after birth. Upon discharge from the maternity hospital, the mother is directed to the consultation by the maternity hospital's pediatrician. Consultations, in turn, receive information about born children from maternity hospitals, and where not 100% of births are covered by maternity assistance, information about the born is obtained by consultation nurses from the district Civil Registry Office. If not all children for whom there is information appear at the consultation (usually the consultation waits 10 days), then a patronage nurse is sent to the families of those who did not appear, who clarifies the reasons for the mother's non-attendance at the consultation, helps the mother with advice, and convinces her to systematically visit the consultation. Attracting a child to the consultation in the first month of his life is very important, because then conditions are created for the most timely and complete influence of the consultation on the mother regarding the proper care, feeding, and upbringing of the child. The third task of patronage—serving sick children at home (medical patronage)—has received especially great development in recent times with the introduction of home care in consultations and the zoning of consultations. The district nurse of the consultation serves the patronage of her doctor's district. This nurse, knowing the home conditions of the children of her district, helps the doctor during the reception, reporting all necessary data about the family's daily life. Receiving a sick child, the doctor gives the nurse specific instructions about those medical measures which the nurse must carry out at home; here the doctor also learns from the nurse about the results of visits made the day before at his own instruction. Thus, a living connection is created, which is necessary in the district work of the doctor and nurse. The visiting of sick children by nurses has very great significance: the nurse teaches the mother to perform the simplest medical measures—how to give an enema, how to feed a child with a spoon, with a dropper, to apply a mustard plaster, to give a medical bath, etc.; the nurse takes measures to create a hygienic environment, especially important for a sick child. In necessary cases, she directs the consultation doctor to the child. The fourth task of patronage is the prevention of infectious diseases in the child's family. A patronage nurse, knowing the worker's family and the surrounding environment, can timely give instructions on how to protect oneself from childhood infections, from syphilis, tbc, gonorrhea, etc. As the work of the consultation expands and deepens, the tasks of patronage also expand. Consultations cover children up to 4 years of age; pedagogical patronage is introduced, having the goal of introducing elementary, basic information about the proper pedagogical regimen. Social-legal (everyday life) offices, when a special examination of the family is necessary, conduct their work through patronage nurses. Patronage, receiving more and more development, is carried out beyond the limits of the home environment, capturing in certain organizational forms the broad children's street (street patronage). To practically teach the proper conduct of a walk, to eradicate the leaving of small children on the street without supervision, to conduct work on the prevention of childhood infections in places of walking and mass gathering of children, to introduce pedagogical principles into the street stay of children, to organize the children's street—these are the main tasks of street patronage. Technique of patronage. During the first visit to a child, the nurse fills out a patronage sheet, where she enters basic information about the child and the living conditions of the family: surname, name, age of the child, housing conditions, data of the child's examination, data on care for him, his feeding, etc. During repeat visits, the nurse notes all practical instructions given to the mother, and all her subsequent observations, advice, and achievements. The patronage sheet is inserted into the child's development history, which is kept by the consultation doctor. In order for the patronage sheets to be filled out accurately, the nurse enters all the data of her observations at home into a special notebook, and, upon arriving at the consultation, copies them into the patronage sheets. On the basis of the records in the patronage sheets, the nurse compiles monthly and annual reports on patronage in her district. The number of patronage visits to each child is different depending on the culture of the parents, the success of the patronage, etc.; experience has shown that on average, 5–6 visits per child per year are sufficient. In the first quarter of the child's life, visits should be more frequent—approximately once a month; later, the nurse visits the child less often, at moments especially important for the child (supplementary feeding, weaning, etc.), according to the instruction of the consultation doctor. There is absolutely no need to conduct patronage in relation to all young children living in the district of a given consultation. At the present time, the majority of consultations conduct patronage only in families of low culture and predominantly in families with a first child. For the conduct of in-depth dispensary observation, consultations of industrial centers single out industrial enterprises of leading industry in their district and even separately the most important workshops at these productions, with the maximum of patronage work being concentrated on serving families working in these shock-work sectors. Only recently, consultations concentrated attention on the patronage of children of the first 6 months; with the introduction of pedagogical work in consultations, this special type of patronage also covers children after one year (pedagogical patronage). The tasks of sanitary-educational patronage in the countryside are basically the same as for urban consultations, but the content of the work is different and depends on the low culture of the population and the still widespread prevalence of harmful customs and prejudices, with which the patronage nurse must fight in the first place. A patronage nurse, being sometimes the only worker for the protection of maternity and infancy in the village, conducts planned preparatory work for the organization of summer and seasonal nurseries. The radius of the patronage nurse's district is usually no more than 5–8 km. To cover patronage in places more distant from the consultation, primary points for the protection of maternity and infancy are organized on the periphery, 8–10 km from the location of the consultation, where a nurse living at this point conducts regular patronage work within a limited radius and where the consultation doctor systematically travels to receive children selected by the patronage nurse. A patronage nurse in the village, along with her direct patronage work, sometimes has to provide first aid, for which special training of the nurse is necessary. Patronage nurses of the rural consultation and primary points arrange talks about the care of an infant, about the significance of consultations for children and women, about the organization of nurseries in collective farms and state farms, etc.

In order for the patronage nurse to have the opportunity to practically teach a mother how to care for a child, to carry out the medical instructions of a physician, and in rural areas to also provide first aid if necessary, a model of a special patronage nurse's bag has been developed, which contains the basic items for care and the simplest medical instruments necessary for carrying out the physician's instructions and providing first aid. While the sanitary-educational and therapeutic patronage of infants is highly developed, organized into specific forms, and is an integral part of consultations, the patronage of pregnant women has become significantly less widespread. The methodology and forms of patronage for pregnant women are generally based on the principles described above, but they are less fully developed. In the majority of consultations, both urban and rural, the patronage of pregnant women is carried out not by a specialized midwife, but by the general patronage nurse of the consultation.