Background: In the early twentieth century, most women in Australia and New Zealand gave birth at home. As in colonial times, women living in the isolated New Zealand backblocks or Australian bush without access to a midwife, nurse or doctor, or women in towns who could not afford their service, gave birth with only a neighbouring woman, husband or older child to help. Most households had a domestic health guide as a source of health information and support in caring for themselves and others. This guide might therefore be the only assistance available to women and their lay attendants during childbirth. Aim: This research aimed to identify the information domestic health guides provided on childbirth, particularly if addressed to a person assisting the woman in the absence of a midwife, nurse or doctor, and to compare it with information midwives were expected to know. Methods: Using historical methodology, the researchers analysed the childbirth information in a range of domestic health guides available in Australia and New Zealand, 1900-1950. The information was also compared with midwifery textbooks and considered within the context of the increasing professionalisation of midwifery to discover how it reflected boundaries between lay and professional knowledge and practice. Findings: Some domestic health guides provided as detailed information as midwifery texts but without their scientific rationale that was a mark of professional knowledge and practice. Conclusion: By providing clear information, domestic health guides could have been a significant part of the culture of self-reliance and mutual aid, and of the cultures of health in both rural and urban environments in New Zealand and Australia in this time period.
Aims and objectives To identify how nurses in the past determined best practice, using the context of New Zealand, 1930–1960. Background In the current context of evidence-based practice, nurses strive to provide the best care, based on clinical research. We cannot assume that nurses in the past, prior to the evidence-based practice movement, did not also have a deliberate process for pursuing best practice. Discovering historical approaches to determining best practice will enrich our understanding of how nurses' current efforts are part of a continuing commitment to ensuring quality care. Design Historical research. Methods The records of the Nursing Education Committee of the New Zealand Registered Nurses' Association, 1940–1959, and the 309 issues of New Zealand's nursing journal, Kai Tiaki, 1930–1960, were analysed to identify the profession's approach to ensuring best practice. This approach was then interpreted within the international context, particularly Canada and the USA. Results For nearly 30 years, nurse leaders collaborated in undertaking national surveys of training hospitals requesting information on different nursing practices. They subsequently distributed instructions for a range of procedures and other aspects of nursing care to standardise practice. Standardising nursing care was an effective way to ensure quality nursing at a time when hospital care was delivered mostly by nurses in training. The reasons for and timing of standardisation of nursing care in New Zealand differed from the international move towards standardisation, particularly in the USA. Conclusions Historically, nurses also pursued best practice, based on standardising nursing procedures. Relevance to clinical practice Examining the antecedents of the present evidence-based approach to care reminds us that the process and reasons for determining best practice change through time. As knowledge and practice continually change, current confident assertions of best practice should and will continue to be challenged in future.