Florence Wald (1917 - )

Pioneer in Hospice Care

By Cynthia C. Adams RN, MSN, EdD

FLORENCE WALD RN, MSN, FAAN, is internationally recognized as a pioneer in improving the care of dying patients in the United States. After World War II, the care of the dying moved from being home-based into the hospital ^{Krisman-Scott, 2001}. The increasing number of hospital beds coupled with a more mobile society and women working out of the home led to a shift in the manner of caring for patients at the end-of-life. This transition from family centered care to institution-based care left the patient in the care of non-family members.

Particularly before the hospice movement, hospitals 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 ^{Krisman-Scott}. Families were typically kept at bay with limited visiting hours and minimal inclusion in the direct care of their loved ones. Hospitals were run efficiently and cost-effectively with little concern for the psychological, social or spiritual needs of the patient, which were not typically considered in designing plans of care. Nursing educators gave modest attention to the care of the dying, focused on recognizing the signs of impending death and care of the body postmortem. In addition, physicians often withheld the full diagnosis and prognosis believing it was better to shield patients and their families from the truth ^{Wald, 1979b}.

Wald was Inspired by Cicely Saunders from Saint Christopher's Hospice in London who designed her hospice as a warm, peaceful setting where patients were assisted to die with dignity, respect and compassion ^{Krisman-Scott}. To learn more about end-of-life care, Wald left her position as Dean at the Yale School of Nursing in 1965 to work with Saunders in the U.K. After working with Saunders in England, she returned to Connecticut and chose an interdisciplinary team from Yale University to conduct research and learn more about the needs of terminally ill patients. Wald organized a series of educational conferences to elevate the consciousness of the community and create a shared vision for improving palliative care ^{Group 1659; Hyry, 2004}.

Florence Wald worked with colleagues in New Haven to design a hospice where the patient and family were at the center of care. Co-founders of the hospice included Katherine Klaus, RN; Rev. Edward Dobihal, Jr.; Father Canny, Catholic priest; Morris Wessel, pediatrician; Ira Goldenberg, oncologic surgeon.

The emphasis in the hospice was on symptom management and creating a caring community around the patient. The patient and family were included in all decisions. The goal was to maintain dignity and the highest quality of life as the developmental task of saying good-bye was addressed ^{Wald, 1979a}.

Bringing in music and the arts, the founders created the first hospice in the United States, which opened in 1971. Under Wald's influence, the hospice movement grew to 1000 hospices in less than 15 years in the United States. The leadership of Florence Wald helped to transform the delivery of healthcare to the dying in America despite great resistance from those who valued the highest levels of technological intervention for the dying ^{Adams, 2008}.

Born in the Bronx, in New York City, on April 19th, 1917, Wald was the younger child of Gertrude Goldschmidt Shorska and Theodore Alexander Shorska ^{Mills, 2003}. Her parents were social activists and rigorously self-educated in the arts and literature. Wald's father was a banker and mother worked in the shipping industry. Registered in the Socialist Party, Wald's parents were committed to social justice and worked to help immigrants adjust to life in America. Dinner table discussions involved active debates over political and policy decisions.

Florence Wald earned a Bachelors degree from Mount Holyoke College and three degrees from Yale University: Master of Nursing, Master or Science, and then an honorary degree of Doctorate of Medical Science ^{Mills, 2003}. She began her career in the New York Visiting Nurse Service and then accepted a position teaching psychiatric nursing 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 ten years at Yale School of Nursing. Wald became a Fellow in the American Academy of Nursing and was honored in Washington D.C. with the title of "Living Legend." She is recognized as a world-renowned leader in nursing research, and a champion in the care of the terminally ill ^{Mills, 2003}. Florence Wald has been inducted into the National Women's Hall of Fame and the Connecticut Women's Hall of Fame. In the last decade, she continued her work to bring hospice care to prisons in the United States. As of this writing in 2008, Florence Wald resides by the sea in Branford, Connecticut.

last updated April 20, 2008

Bibliography

Adams, C. (2008). Dying with Dignity in America: The Transformational Leadership of Florence Wald. Unpublished doctoral dissertation in Educational Leadership, University of Hartford.

Buck, J. (2005). Rights of passage: Reforming care of the dying 1965-1986 . Unpublished doctoral dissertation, University of Virginia, Charlottesville.

Group 1659, Series 1, Box 3, Folder 26, The Florence and Henry Wald Papers, Yale University Library Archives.

Hyry, T. (2004). Guide to Florence and Henry Wald papers: Hospice. Inc. files, Yale School of Nursing Files. Retrieved from manuscripts and archives on November 17, 2004 at http://mssa.library.yale.edu/findaids/stream.php?xmlfile=mssa.ms.1659.xml

Krisman-Scott, M. A. (2001). The room at the end of the hall: Care of the dying, 1944-1976. Unpublished doctoral dissertation in Nursing, University of Pennsylvania.

Mills, Monica. (2003). Interview with Florence Wald, The Oral History Archive, Connecticut Women's Hall of Fame. Retrieved 04-20-08 http://www.cwhf.org/browse_hall/hall/people/wald.php

Saunders, C. (2000). The evolution of palliative care. Patient Education and Counseling, 41(1), pp. 7-13.

Wald, F. (1969a). Development of an interdisciplinary team to care for patients and their families. American Nurses Association Clinical Conferences.

Wald, F. (1969b). For everything there is a season and a time to every purpose. The New Physician, pp. 278-285.

Wald, F. (1986) In quest of the spiritual component of care of the terminally ill. Proceedings of a colloquium May 3-4, 1986, New Haven: Yale School of Nursing.

Wald, F.S., Foster, Z., and Wald, H.J., (1980). The hospice movement as a health care reform. Nursing Outlook, 28(3), 173-8.

 
Written by:
Cynthia C. Adams RN, MSN, EdD
Director of Nursing
Capital Community College
950 Main Street
Hartford, Connecticut 06103 USA
phone: +1-860 906-5151
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