Florence Sophie Wald

Florence Wald (born 1917) is credited with starting the hospice movement in the United States. Wald's model for hospice care has served as the basis for the treatment of dying patients and their families.

Nurse and Yale Dean

Florence Wald was born Florence Sophie Schorske on April 19, 1917, in New York City. Her parents were Theodore Alexander Schorske and Gertrude Gold-schmidt Schorske. Wald had an older sibling, but little else is known about her childhood. Wald was raised and educated in Scarsdale, New York, and graduated from Mt. Holyoke College in 1938. She received a master's degree in nursing from Yale University in 1941.

Wald's first nursing job was as a staff nurse at the Children's Hospital in Boston in 1941 and 1942. During the next 15 years, she worked at various nursing jobs in New York. She worked at the Henry Street Visiting Nurse Service and held research positions at the cornea research laboratory of the New York City Eye Bank and in the Surgical Metabolism Unit of the College of Physicians and Surgeons. During the final stages of World War II, Wald served in the nursing branch of the Women's Army Corps.

Wald began teaching at Rutgers University School of Nursing in New Jersey in 1955. In 1957, she became assistant professor of psychiatric nursing at Yale University School of Nursing. A year later, she was named acting dean of the nursing school and in 1959 she became Yale's permanent dean. She held the position until 1967. Wald married Henry Wald, a health facility planner, in 1959. The couple had two children: Joel David Wald and Shari Johanna Wald.

During Wald's tenure as dean, she initiated many changes in the nursing curriculum, guiding the program to a more scholarly approach. One of her concerns when developing the new curriculum was the involvement of the patient, his or her family, and nurses in the patient's care. Normally in this era, doctors made all medical decisions and their authority was not questioned.

Met English Hospice Advocate

In 1963, Wald met Dr. Cicely Saunders, an English physician who was a pioneer in the field of hospice. Saunders, who had been trained as a nurse and physician, visited the United States to share her ideas about hospice care. Saunders had worked for two years in clinical trials of palliative care in St. Joseph's Hospice in London before establishing her own hospice facility, St. Christopher's, in London.

Saunders told Yale medical students about her approach to treating terminally ill cancer patients. She advocated easing pain and suffering in the final stages of life so the patients and their families could concentrate on their relationships and prepare for death. Saunders's goal was for patients to discover what they wanted, not yield to doctors' decisions to prolong life as long as possible. Pain-relieving drugs were an essential part of hospice care.

Wald described her reaction to Saunders in the essay "The Emergence of Hospice Care in the United States" in the book Facing Death: Where Culture, Religion, and Medicine Meet. She wrote, "She made an indelible impression on me, for until then I had thought nurses were the only people troubled by how a terminal illness was treated. In the Yale University Nursing School, where I was dean, faculty and students had found themselves at cross purposes with doctors when patients asked questions about their illness."

Wald explained that doctors evaded questions about treatments that failed and rebuffed nurses who tried to intervene on behalf of patients. Nurses were beginning to realize the importance of patients expressing their thoughts and feelings about treatment and getting involved in decisionmaking. But in the male-dominated medical profession, nurses could do little more than stand by as patients suffered through never-ending treatments that did not work.

As dean of the nursing school, Wald sought to revamp nursing education to focus on patients and their families and involve them in their medical care. Fortunately, the time was right for change. During the 1960s, among other social movements, women were demanding equal rights and opportunities, and institutional authority was generally being questioned.

The women's movement affected how doctors and nurses related. Wald explained, "… the women's movement gave promise that the gender barrier between doctors (predominantly men) and nurses (predominantly women) would be lowered—that doctors would hear what nurses said and nurses would challenge doctors. The health care hierarchy was shaken. Nurses became more capable of expressing themselves and began to expect recognition."

Saunders returned to the United States over the next few years, and the hospice movement attracted more and more attention. Saunders and Elizabeth Kubler-Ross, an expert on death and dying, traveled around the country giving lectures on the hospice movement.

Dedicated to Hospice Care

Wald stepped down as dean in 1967 and began working with others who wanted to introduce the hospice concept in the United States. Although she was no longer dean, Wald continued to work at Yale. She was a research associate from 1969 to 1970 and a clinical associate professor from 1970 to 1980.

In 1969, Wald served a one-month internship at St. Christopher's Hospice in London, the hospice founded by Saunders. When she returned to the United States, she formed an interdisciplinary team of doctors, clergy and nurses to study the needs of dying patients. The project was sponsored by the Yale University Schools of Nursing and Medicine. Funding came from the Nursing Division of the United States Public Health Service and the American Nurses Foundation.

Saunders served as the group's mentor from 1969 to 1971. The team included Wald; another nurse, Katherine Klaus; physicians Dr. Ira Goldenbert and Dr. Morris Wessel; Fathers Don McNeil and Robert Canney, and Pastor Fred Auman. The group worked with terminally ill patients in hospitals, homes and nursing homes. Wald and Klaus provided nursing care and kept diaries of observations, conversations and feelings of patients and their families. The research helped them understand the needs of the patients and their families and where the health care industry fell short in meeting those needs. They studied pain management and learned that it was a very important and little-understood component of hospice care.

Interest in hospice among professionals and the public was "unstoppable," Wald said. In 1974, the interdisciplinary team, along with Henry Wald, founded the country's first hospice, Connecticut Hospice in Branford, Connecticut. Initially, the hospice provided home care only; in 1980 an inpatient facility was added.

In the following years, many hospices opened around the country using the model that Wald created. It called for holistic and humanistic care for patients and required caregivers to understand death and the needs of the dying person and his or her family. Yale School of Nursing News quoted Wald, "From the nurse's point of view hospice care is the epitome of good nursing. It enables the patient to get through the end of life on their own terms. It is a holistic approach, looking at the patient as an individual, a human being. The spiritual role nurses play in the end of life process is essential to both patients and families."

Received Many Awards

Wald was recognized for her pioneering efforts in hospice care. She received honorary degrees from Yale, University of Bridgeport and Mt. Holyoke College. She was widely published and earned many honors. She received a Founders Award from the National Hospice Association. She received the American Academy of Nursing's Living Legend Award in 2001. The Connecticut Nurses Association established the Florence S. Wald Award for outstanding contributions to nursing practice in her honor. In 1996, Wald was inducted into the American Nurses Association Hall of Fame. Two years later, she was inducted into the National Women's Hall of Fame and in 1999 the Connecticut Hall of Fame. In April of 2004 she received the Connecticut Treasure Award.

During the 1990s, when Wald was in her 80s, she became involved in prison hospice programs. In an interview in JAMA: Journal of the American Medical Association, she explained that the needs of dying prisoners are different because they face death knowing they have not had successful lives. She found that inmates serving as hospital volunteers gained confidence from the situation. "It shows that even in this terrible situation, something good can happen, a sense of possibility emerges."

During the 1990s, Wald expressed her beliefs about health care in America and declared her support for physician-assisted suicide. "There are cases in which either the pain or the debilitation the patient is experiencing is more than can be borne, whether it be economically, physically, emotionally, or socially. For this reason, I feel a range of options should be available to the patient, and this should include assisted suicide."

In JAMA, Wald commented on the role of hospice care and its future. She believed that family, doctors and nurses should all be caregivers and that health maintenance should involve birthing centers, schools, health maintenance organizations, centers for aging and hospices.

"Hospice care for the terminally ill is the end piece of how to care for patients from birth on. It is a patient-family-based approach to health care that belongs in the community with natural childbirth, school-based health care, mental health care, and adult care…" she wrote. "As more and more people—families of hospice patients and hospice volunteers—are exposed to this new model of how to approach end-of-life care, we are taking what was essentially a hidden scene, death, an unknown, and making it a reality. We are showing people that there are meaningful ways to cope with this very difficult situation."

Books

Spiro, Howard M., Mary G. McCrea Curnen, and Lee Palmer Wandel, eds., Facing Death: Where Culture, Religion, and Medicine Meet, New Haven: Yale University Press, 1996.

Women in World History: A Biographical Encyclopedia, Anne Commire, editor, Yorkin Publications, 1999.

Periodicals

JAMA: Journal of the American Medical Association, May 12, 1999.

M2 Presswire, April 6, 2004.

Online

"Florence Sophie Wald," Biography Resource Center Online, Gale Group, 2002.

"Past Yale School of Nursing Dean and Leader in Nursing Research Awarded Title 'Living Legend' by the American Academy of Nursing, Yale School of Nursing News, Yale University School of Nursing website, 2001,http://www.info.med.yale.edu/nursing (November 10, 2003).